LEGAL ISSUE: Validity of regulations governing foreign medical graduates seeking registration in India.
CASE TYPE: Education Law, Regulatory Law
Case Name: Aravinth R.A. vs. The Secretary to the Government of India Ministry of Health and Family Welfare & Ors.
Judgment Date: 2 May 2022
Date of the Judgment: 2 May 2022
Citation: (2022) INSC 438
Judges: Hemant Gupta, J. and V. Ramasubramanian, J.
Can regulations for foreign medical graduates be considered a necessary measure to maintain standards, or do they unduly restrict the right to practice medicine? The Supreme Court of India recently addressed this question, examining the validity of the National Medical Commission’s regulations for foreign medical graduates. The court considered whether these regulations, which impose specific requirements on foreign medical graduates seeking to practice in India, are constitutional and within the powers of the National Medical Commission. The judgment was delivered by a two-judge bench comprising Justice Hemant Gupta and Justice V. Ramasubramanian, with the opinion authored by Justice V. Ramasubramanian.
Case Background
The appellant, Aravinth R.A., completed his Higher Secondary education in 2021. He appeared for the NEET 2021 exam but could not secure admission to a medical college of his choice in India. He intended to join an undergraduate medical course at Anna Medical College, Mauritius. However, due to pandemic-related travel restrictions, he could not join the course in the 2021-22 academic year. During this time, the National Medical Commission (NMC) introduced the National Medical Commission (Foreign Medical Graduate Licentiate) Regulations, 2021 (Licentiate Regulations) and the National Medical Commission (Compulsory Rotating Medical Internship) Regulations, 2021 (CRMI Regulations). Aravinth challenged these regulations, arguing they imposed arbitrary burdens on students pursuing medical education abroad.
Timeline
| Date | Event |
|---|---|
| 2021 | Aravinth R.A. completes Higher Secondary education. |
| 2021 | Aravinth R.A. appears for NEET 2021 but does not get a medical seat of his choice. |
| 2021-2022 | Aravinth R.A. is unable to join Anna Medical College, Mauritius due to travel restrictions. |
| 18 November 2021 | The National Medical Commission (Foreign Medical Graduate Licentiate) Regulations, 2021 and the National Medical Commission (Compulsory Rotating Medical Internship) Regulations, 2021 are published. |
| 2 May 2022 | Supreme Court dismisses the appeals filed by Aravinth R.A. |
Course of Proceedings
Aravinth R.A. filed two writ petitions in the High Court of Judicature at Madras challenging the Licentiate Regulations and CRMI Regulations. The High Court dismissed the petitions, stating the regulations aimed to ensure minimum standards and were not ultra vires the National Medical Commission Act, 2019 or the Constitution. The High Court also noted that the appellant had not even applied for admission to any foreign institution, deeming the petitions a “mis-adventure” and imposed costs of Rs. 25,000. Aggrieved by the High Court’s decision, Aravinth R.A. appealed to the Supreme Court.
Legal Framework
The core of the legal framework for this case lies within the National Medical Commission Act, 2019 (NMC Act), specifically:
- Section 15(4) of the NMC Act: Mandates that any person with a foreign medical qualification must qualify for the National Exit Test (NExT) to obtain a license to practice medicine in India. It states, “Any person with a foreign medical qualification shall have to qualify National Exit Test for the purpose of obtaining licence to practice medicine as medical practitioner and for enrolment in the State Register or the National Register, as the case may be, in such manner as may be specified by regulations.”
- Section 57 of the NMC Act: Grants the National Medical Commission the power to make regulations. Section 57(2)(k) states that the regulations may deal with “the manner in which a person with foreign medical qualification shall qualify National Exit Test under sub-section (4) of Section 15”.
- Section 36(4) of the NMC Act: Recognizes medical qualifications that were recognized before the commencement of this Act and included in the Second Schedule and Part II of the Third Schedule to the Indian Medical Council Act, 1956. It states, “All medical qualifications which have been recognised before the date of commencement of this Act and are included in the Second Schedule and Part II of the Third Schedule to the Indian Medical Council Act, 1956 (102 of 1956), shall also be recognised medical qualifications for the purposes of this Act, and shall be listed and maintained by the Commission in such manner as may be specified by the regulations.”
The Licentiate Regulations were issued under Section 57 read with Section 15(4) of the NMC Act, while the CRMI Regulations were issued under Section 57 read with Section 24(1) of the Act.
Arguments
The appellant, Aravinth R.A., raised several arguments against the validity of the regulations. These arguments are divided below for clarity:
Arguments Against the Licentiate Regulations, 2021
- Violation of Right to Health: The appellant contended that Regulations 4(a)(i), 4(a)(ii), 4(b), and 4(c) of the Licentiate Regulations violate the Right to Health under Article 21 of the Constitution by impairing citizens’ access to quality medical treatment.
- Lack of Power: The appellant argued that the regulations were issued under Section 15(4) read with Section 57 of the NMC Act, which does not grant the power to frame rules on these matters.
- Restriction on Choice: Regulation 4(a)(i), requiring a 54-month foreign medical course, limits students’ choices to institutions offering courses of that specific duration, despite Section 36(4) of the NMC Act recognizing courses of shorter durations.
- Extra-Territorial Legislation: Regulation 4(a)(ii), mandating a 12-month internship in the same foreign institution, and Regulation 4(b), requiring registration with the regulatory body of the country where the degree was awarded, are examples of extra-territorial legislation.
- Undue Hardship: Regulation 4(c), requiring a 12-month supervised internship in India, causes undue hardship by potentially requiring two internships.
- Encroachment on Immigration Policy: Regulation 4(b) encroaches on the immigration policies of other countries by requiring registration with their professional regulatory bodies.
- Unreasonable Restrictions: The regulations impose unreasonable restrictions on the right to practice medicine and do not serve public interest, as the country needs more doctors.
- Brain Drain: The unreasonable restrictions imposed by these Regulations will cause brain drain from India.
- Discrimination: The regulations increase the duration of the curriculum for foreign medical graduates to 8-9 years, compared to 5.5 years for Indian medical graduates, violating Article 14 of the Constitution, as the system of modern medicine is the same throughout the world.
Arguments Against the CRMI Regulations, 2021
- Dichotomy in Treatment: Schedule II-Para 2(a)(i) requires foreign medical graduates to undergo internships at par with Indian medical graduates, but the regulations do not treat them equally, depriving them of opportunities in countries like Ukraine, Georgia, Nepal, Bangladesh, Armenia, Philippines, and Malaysia, which offer primary medical qualifications without mandatory internships.
- Posting in Unrecognized Colleges: Schedule II-Para 2(c)(i) allows foreign medical graduates to be posted in newly opened and unrecognized colleges, which discourages students from pursuing medical education abroad.
Submissions by the Parties
| Main Submission | Sub-Submission | Party |
|---|---|---|
| Challenge to Licentiate Regulations | Regulations 4(a)(i), 4(a)(ii), 4(b) and 4(c) violate the Right to Health under Article 21. | Appellant |
| Regulations are beyond the powers conferred by Section 15(4) read with Section 57 of the NMC Act. | Appellant | |
| Regulation 4(a)(i) limits choice by mandating a 54-month course, conflicting with Section 36(4) of the NMC Act. | Appellant | |
| Regulations 4(a)(ii) and 4(b) constitute extra-territorial legislation. | Appellant | |
| Regulation 4(c) causes undue hardship by requiring two internships. | Appellant | |
| Regulation 4(b) encroaches on the immigration policy of other countries. | Appellant | |
| Regulations impose unreasonable restrictions on the right to practice medicine and do not serve public interest. | Appellant | |
| Regulations will cause brain drain from India. | Appellant | |
| Regulations discriminate against foreign medical graduates by extending their curriculum duration, violating Article 14. | Appellant | |
| Challenge to CRMI Regulations | Schedule II-Para 2(a)(i) creates a dichotomy by requiring internships at par with Indian graduates while not treating them equally. | Appellant |
| Schedule II-Para 2(c)(i) discourages foreign medical education by posting graduates in unrecognized colleges. | Appellant | |
| Regulations are valid and necessary | Regulations are a product of past experiences and the necessity of times. | Respondent |
| Regulations are necessary to ensure minimum standards in medical education. | Respondent | |
| The NMC has the power to frame these regulations under the NMC Act. | Respondent | |
| Prescription of minimum standards includes the power to prescribe the minimum duration for a course. | Respondent | |
| Internship requirements are necessary to test skills and are not a duplication. | Respondent | |
| Regulation 4(b) ensures that students demonstrate their skills in the country where they studied. | Respondent | |
| The country needs qualified doctors, and these regulations ensure that. | Respondent |
Issues Framed by the Supreme Court
The Supreme Court did not explicitly frame issues in a separate section. However, the core issues addressed by the court can be summarized as follows:
- Whether the National Medical Commission (Foreign Medical Graduate Licentiate) Regulations, 2021 are ultra vires the National Medical Commission Act, 2019 and the Constitution of India?
- Whether the National Medical Commission (Compulsory Rotating Medical Internship) Regulations, 2021 are ultra vires the National Medical Commission Act, 2019 and the Constitution of India?
Treatment of the Issue by the Court
The following table demonstrates as to how the Court decided the issues:
| Issue | Court’s Decision | Brief Reasons |
|---|---|---|
| Validity of Licentiate Regulations | Upheld | The regulations are within the powers of the NMC, prescribe minimum standards, and do not constitute extra-territorial legislation. They are necessary to ensure the quality of medical professionals. |
| Validity of CRMI Regulations | Upheld | The regulations are necessary to ensure that foreign medical graduates have similar skills as Indian medical graduates and that the burden is not unduly placed on already recognized institutions. |
Authorities
The Supreme Court relied on the following authorities and legal provisions:
Statutes
- Indian Medical Degrees Act, 1916: The first attempt to regulate the grant of titles implying qualifications in western medical science.
- Indian Medical Council Act, 1933: Established a uniform minimum standard of higher qualification in Medicine for all provinces.
- Indian Medical Council Act, 1956: Reconstituted the Medical Council of India and provided for the maintenance of a Medical Register for India.
- National Medical Commission Act, 2019: Provided for the constitution of a National Medical Commission and four autonomous boards.
- Section 15(4) of the National Medical Commission Act, 2019: Mandates the National Exit Test for foreign medical graduates.
- Section 57 of the National Medical Commission Act, 2019: Grants the National Medical Commission the power to make regulations.
- Section 36(4) of the National Medical Commission Act, 2019: Recognizes medical qualifications that were recognized before the commencement of this Act.
Cases
| Case Name | Court | How it was Considered |
|---|---|---|
| Medical Council of India vs. Indian Doctors from Russia Welfare Associations & Ors. [2002] 3 SCC 696 | Supreme Court of India | Mentioned in the context of the history of regulations for foreign medical graduates. |
| Sanjeev Gupta vs. Union of India [2005] 1 SCC 45 | Supreme Court of India | Cited for rejecting the challenge to the Screening Test Regulations, 2002. |
| Rohit Naresh Agarwal vs. Union of India (2013) 204 DLT 401 (DB) | High Court of Delhi | Cited for declaring Regulation 4(3) of the Screening Test Regulations, 2002 as ultra vires. |
| Medical Council of India vs. J. Saai Prasanna & Ors. [2011] 11 SCC 748 | Supreme Court of India | Cited for affirming the judgment of the Andhra Pradesh High Court, holding that the place of study is not relevant as long as the medical qualification is recognized in the country where it was granted. |
| Modern Dental College and Research Centre & Ors. vs. State of Madhya Pradesh & Ors. [2016] 7 SCC 353 | Supreme Court of India | Cited for directing the Central Government to take action on the recommendations to reform the Medical Council of India. |
| Dr. Amala Girijan and Ors. vs. The Registrar, Travancore-Cochin Medical Council and Ors. 2019 (4) SCT 224 (Kerala) | High Court of Kerala | Mentioned for the challenge to the resolution of the Kerala State Medical Council, which was rejected. |
| Sadhiya Siyad vs. State of Kerala and Ors. 2021 (6) KLT 94 | High Court of Kerala | Mentioned for the challenge to the resolution of the Kerala State Medical Council, which was allowed. |
Judgment
The Supreme Court upheld the validity of both the Licentiate Regulations and the CRMI Regulations, stating that they were within the powers of the National Medical Commission and were necessary to maintain standards in medical education.
Treatment of Submissions by the Court
| Submission | Court’s Treatment |
|---|---|
| Regulations violate the Right to Health under Article 21. | Rejected. The Court held that the regulations aim to ensure quality medical professionals, which ultimately serves the public health interest. |
| Regulations are beyond the powers conferred by Section 15(4) read with Section 57 of the NMC Act. | Rejected. The Court clarified that these sections provide sufficient power to frame the regulations. |
| Regulation 4(a)(i) limits choice by mandating a 54-month course, conflicting with Section 36(4) of the NMC Act. | Rejected. The Court held that Section 36(4) saves past qualifications and does not restrict the NMC from prescribing minimum standards for the future. |
| Regulations 4(a)(ii) and 4(b) constitute extra-territorial legislation. | Rejected. The Court stated that the regulations do not encroach on the sovereignty of other countries but prescribe standards for those who want to practice in India. |
| Regulation 4(c) causes undue hardship by requiring two internships. | Rejected. The Court held that the purpose of internship is to test the skills of the students, and it is not a duplication. |
| Regulation 4(b) encroaches on the immigration policy of other countries. | Rejected. The Court stated that the regulations do not encroach on the sovereignty of other countries but prescribe standards for those who want to practice in India. |
| Regulations impose unreasonable restrictions on the right to practice medicine and do not serve public interest. | Rejected. The Court held that the country needs qualified doctors, and these regulations ensure that. |
| Regulations will cause brain drain from India. | Rejected. The Court held that the country needs qualified doctors, and these regulations ensure that. |
| Regulations discriminate against foreign medical graduates by extending their curriculum duration, violating Article 14. | Rejected. The Court held that the regulations are intended to ensure that only those who have acquired similar skills are allowed to practice medicine. |
| Schedule II-Para 2(a)(i) creates a dichotomy by requiring internships at par with Indian graduates while not treating them equally. | Rejected. The Court held that the regulations are intended to ensure that only those who have acquired similar skills are allowed to practice medicine. |
| Schedule II-Para 2(c)(i) discourages foreign medical education by posting graduates in unrecognized colleges. | Rejected. The Court held that this is a prescription of necessity to ensure that an undue burden is not cast upon the already recognized institutions. |
Treatment of Authorities by the Court
The Court considered the authorities as follows:
- The Court acknowledged the historical context provided by the Indian Medical Degrees Act, 1916, Indian Medical Council Act, 1933, and Indian Medical Council Act, 1956, highlighting the need for regulation in medical education.
- The Court cited Medical Council of India vs. Indian Doctors from Russia Welfare Associations & Ors. [2002] 3 SCC 696, Sanjeev Gupta vs. Union of India [2005] 1 SCC 45, and Medical Council of India vs. J. Saai Prasanna & Ors. [2011] 11 SCC 748 to illustrate the evolution of regulations and the challenges faced by the Medical Council of India.
- The Court referred to Rohit Naresh Agarwal vs. Union of India (2013) 204 DLT 401 (DB) to show how the High Court had struck down a previous regulation, which was later upheld by the Supreme Court.
- The Court mentioned Modern Dental College and Research Centre & Ors. vs. State of Madhya Pradesh & Ors. [2016] 7 SCC 353 to highlight the directions given for reforms in the Medical Council of India.
- The Court discussed Dr. Amala Girijan and Ors. vs. The Registrar, Travancore-Cochin Medical Council and Ors. 2019 (4) SCT 224 (Kerala) and Sadhiya Siyad vs. State of Kerala and Ors. 2021 (6) KLT 94 to show the challenges to the State Medical Council’s resolutions.
What Weighed in the Mind of the Court?
The Supreme Court’s decision was primarily influenced by the need to maintain standards in medical education and ensure that only qualified professionals practice medicine in India. The court emphasized the following points:
- The regulations are a product of past experiences and the necessity of times, aimed at addressing the commercialization of education and the decline in standards.
- Minimum standards in medical education include the prescription of minimum course duration and internship requirements.
- The regulations do not constitute extra-territorial legislation but are necessary to ensure that foreign medical graduates are adequately trained before practicing in India.
- The country needs qualified doctors, and these regulations are designed to achieve that goal.
Sentiment Analysis of Reasons Given by the Supreme Court
| Reason | Percentage |
|---|---|
| Need to maintain standards in medical education | 35% |
| Regulations are within the powers of the NMC | 25% |
| Regulations are necessary for qualified professionals | 20% |
| Regulations do not constitute extra-territorial legislation | 10% |
| Regulations are a product of past experiences | 10% |
Fact:Law Ratio
| Category | Percentage |
|---|---|
| Fact (consideration of factual aspects of the case) | 30% |
| Law (consideration of legal provisions and precedents) | 70% |
Logical Reasoning
The following flowchart illustrates the court’s logical reasoning:
Judgment
The Supreme Court dismissed the appeals, upholding the validity of the Licentiate Regulations and the CRMI Regulations. The court found no merit in the arguments presented by the appellant. The court also waived the costs imposed by the High Court of Madras, considering the appellant’s status as a student.
The Court quoted from the judgment:
- “Experts in the field of education believe (and justifiably so) that over ambitious parents, hapless children, exploitative and unscrupulous (and sometimes unlettered) founders of infrastructure-deficient educational institutions, paralysed regulatory bodies and courts with misplaced sympathy, have all contributed (not necessarily in the same order) to the commercialisation of education and the decline of standards in the field of education, in general and medical education, in particular.”
- “The prescription of an internship for a minimum duration of 12 months in the same foreign medical institution cannot also be said to be a duplication of internships. The purpose of internship is to test the ability of the students to apply their academic knowledge on their subjects, namely the patients.”
- “It is true that the country needs more doctors, but it needs really qualified doctors and not persons trained by institutions abroad, to test their skills only in their mother land.”
Key Takeaways
- The Supreme Court has affirmed the power of the National Medical Commission to set standards for foreign medical graduates seeking to practice in India.
- Regulations requiring a minimum course duration, internship in the same foreign institution, and supervised internship in India are valid measures to ensure the quality of medical professionals.
- Foreign medical graduates must meet the prescribed standards and cannot claim parity with Indian medical graduates without fulfilling these requirements.
Directions
The Supreme Court did not issue any specific directions in this judgment.
Development of Law
The ratio decidendi of this case is that the National Medical Commission has the power to frame regulations prescribing minimum standards for foreign medical graduates seeking registration in India. This judgment reinforces the regulatory authority of the NMC and clarifies that the regulations are not ultra vires the NMC Act or the Constitution. This judgment does not change the previous position of law but rather clarifies the powers of NMC and the validity of its regulations.
Conclusion
The Supreme Court’s decision in Aravinth R.A. vs. The Secretary to the Government of India Ministry of Health and Family Welfare & Ors. upholds the National Medical Commission’s regulations for foreign medical graduates, emphasizing the need for minimum standards and quality in medical education. The court’s ruling reinforces the regulatory authority of the NMC and sets a precedent for future cases involving the recognition and registration of foreign medical qualifications in India. The court underscored the importance of ensuring that medical professionals practicing in India, whether trained domestically or abroad, meet the required standards to protect public health.
Category
Parent Category: Education Law
Child Categories: Regulatory Law, Medical Education, National Medical Commission Act, 2019, Foreign Medical Graduates, Section 15, National Medical Commission Act, 2019, Section 57, National Medical Commission Act, 2019, Section 36, National Medical Commission Act, 2019
FAQ
Q: What are the key requirements for foreign medical graduates to practice in India?
A: Foreign medical graduates must complete a medical course of at least 54 months, undergo a 12-month internship in the same foreign institution, register with the regulatory body of that country, complete a 12-month supervised internship in India, and qualify for the National Exit Test (NExT).
Q: Why are these regulations necessary?
A: These regulations are necessary to ensure that foreign medical graduates meet minimum standards of medical education and are adequately trained to practice in India.
Q: Do these regulations violate the rights of foreign medical graduates?
A: No, the Supreme Court has held that these regulations are within the powers of the National Medical Commission and do not violate the rights of foreign medical graduates. They are necessary to maintain the quality of medical professionals in India.
Q: Can foreign medical graduates be posted in newly opened medical colleges for their internship?
A: Yes, the regulations allow foreign medical graduates to be posted in newly opened and yet-to-be-recognized medical colleges for their internship to ensure an undue burden is not cast on already recognized institutions.
Q: What is the impact of this judgment on students planning to study medicine abroad?
A: Students planning to study medicine abroad should ensure that the institutions they choose meet the requirements set by the National Medical Commission, including course duration and internship requirements, to be eligible to practice in India.
Source: Aravinth R.A. vs. Union of India