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Rajya Sabha Committee recommendations on NMC Bill Excerpts

Dr KK Aggarwal

The IMA has been opposing the proposed NMC Bill in its present format on several grounds. Following a country-wide 12-hour strike on 2nd January this year, the proposed NMC Bill was referred to a Parliamentary Standing Committee.

The Rajya Sabha Committee considered each clause of the proposed NMC Bill and gave its recommendations (as below) on each in Chapter 4 of its report “109th Report on the National Medical Commission Bill, 2017 (Presented to the Rajya Sabha on 20th March, 2018)  (Laid on the Table of Lok Sabha on 20th March, 2018)”.

4.2 This clause defines various terms and expressions [medial institution] used in the proposed Act.

 4.2.1    The Ministry may examine the suggestion stated above for providing more clarity to the definition of ‘medical institution’ as given in clause2(i).

 4.4          This clause provides for composition of the National Medical Commission and appointment and qualifications of its constituent Members. The Commission shall be a twenty-five Member body comprising of chairperson, member-secretary, twelve ex-officio Members and eleven part-time Members. Of the part-time Members, three shall be from non-medical background and five shall be elected Members from among registered medical practitioners.

 4.4.4   The Committee held detailed discussion on this clause. It has received various suggestions not only to increase the strength of the Commission but also to increase the representation of States/UTs in the Commission. On this issue, it observes that three members to be appointed as part time Members of the Commission on rotational basis from amongst the nominees of the States and Union Territories in the Medical Advisory Council for a term of two years, is too small a number to have an effective participation of the States/UTs in the Commission. The Committee also observes that the strength of the Commission should be increased for its effective functioning. The Committee further notes that the uneven composition of the Commission wherein 80% of its members are nominated as out of 25 members only 5 will be elected members reflects lack of proper representation of elected medical professionals in the composition of the Commission.

4.4.5   The Committee, therefore, keeping in view the representative and federal character of the country, recommends that the total strength of the Commission be increased from 25 members to 29 members. The Committee also recommends that out of these 29 members, besides Chairperson of the Commission, 6 members should be ex officio members, 9 should be elected by registered medical practitioners from amongst themselves, 10 members should be from amongst the nominees of the States and Union Territories besides 3 part-time members appointed from amongst person having special knowledge and professional experience as mentioned in the clause 4(4)(a). The Committee would like that the electoral college for the members to be elected by the medical practitioners must be well defined in the Bill itself.

4.4.6   The Committee also recommends that the ex officio Member Secretary of the Commission should assist the Commission as its Secretary and shall not be a Member of the Commission.

4.4.7   In view of the above, the Committee recommends the composition of the Commission as under:-

1. a Chairperson;
2. six ex officio Members; and
3. twenty two part-time Members.

4.4.8   Further, the Committee recommends following six persons as the ex officio Members of the Commission, namely:-

1. the President of the Under-Graduate Medical Education Board;
2. the President of the Post-Graduate Medical Education Board;
3. the President of the Medical Assessment and Rating Board;
4. the Director General of Health Services, Directorate General of Health Services, New Delhi
5. the Director General, Indian Council of Medical Research;
6. one person to represent the Ministry of the Central Government dealing with Health and Family Welfare, not below the rank of Secretary/Additional Secretary to the Government of India, to be nominated by that Ministry.

4.4.9   The Committee also recommends that the following twenty two persons shall be appointed as part-time Members of the Commission, namely:—

(a)      three Members to be appointed from three different fields amongst persons of ability, integrity and standing, who have special knowledge and professional experience in such areas including management, law, medical ethics, health research, patient rights advocacy, science and technology and economics;

(b)      ten Members to be appointed on rotational basis from amongst the nominees of the States and Union Territories in the Medical Advisory Council for a term of two years in such manner as may be prescribed;

(c)      nine Members to be elected by the registered medical practitioners from amongst themselves from such regional constituencies, and in such manner, as may be prescribed.

4.4.10 The Committee also recommends that clause 4(2) wherein the requisite qualifications for the Chairperson of the Commission are prescribed may be amended as follows:-

‘The Chairperson shall be a medical professional of outstanding ability, proven administrative capacity and integrity, possessing a recognized postgraduate degree in any discipline of medical sciences and having experience of not less than twenty years in the field of medical sciences, out of which at least ten years shall be as a leader in the area of medical education.’

4.4.11 Subject to the above recommendations, the clause is adopted.

 4.5     This clause provides for composition of a Search Committee for appointment of the Chairperson, Members and Secretary of the Commission under the proposed Act. The Committee shall be chaired by the Cabinet Secretary and include three experts nominated by the Central Government of which two shall be with the experience in medical field and one from non-medical background. One of the elected medical Members in National Medical Commission shall also be a Member of this Committee. The Chief Executive Officer, National Institution for Transforming India and Secretary to the Government of India, in charge of the Ministry of Health and Family Welfare, are the other Members.

 4.5.3     The Committee understands that NITI Aayog is mandated to provide directional and policy inputs to the Government of India for formulation of strategic and long term policies and programmes. The role of NITI Aayog is to chalk out plan and advise the Government on policy matters. The Committee, however, observes that NITI Aayog has been instrumental in drafting the NMC Bill and hence its own presence in the Search Committee for appointment of Chairperson and Members of the Commission tantamounts to conflict of interest.

4.5.4     The Committee, therefore, recommends for the following composition of the Search Committee:

1. the Cabinet Secretary –Chairperson;
2. three experts, possessing outstanding qualifications and experience of not less than twenty-five years in the field of medical education, public health education and health research, to be nominated by the Central Government —Members;
3. two experts, from amongst the  part-time  Members  referred to,  in clause (c) of sub-section (4) of section 4, to be nominated by the Central Government in such a manner as may be prescribed — Members;
4. one person, possessing outstanding qualifications and experience of not less than twenty-five years in the field of management or law or economics or science and technology, to be nominated by the Central Government —Member;
5. the Secretary to the Government of India in charge of the Ministry of Health and Family Welfare, to be the Member Secretary for the Search Committee. The Member Secretary will not have any voting rights.

4.5.5     Subject to the above recommendations, the clause is adopted.

 4.6          This clause provides the terms and conditions of service of the Chairperson and Members of the Commission. It specifies that they shall hold office for a term not exceeding four years and will not be eligible for extension or reappointment.

 4.6.4      The Committee observes that the clause 6(6) authorizes the Chairperson or Member of the NMC for accepting any employment in any capacity including as a consultant or expert in any private medical institution after the gap of one year, consequent to his demitting office. Keeping in view both the provisos of the Bill on relaxation in appointment by the Central Government, the Committee is strongly of the view that the cooling off period of one year may be extended to two years so that there is no scope left for conflict of interest in this matter. The Committee, therefore, recommends for a cooling period of two years instead of proposed one year in clause 6(6).

4.6.5      Subject to the above recommendation, the clause is adopted.

 This clause provides for appointments of Secretary, experts, professionals, officers and other employees of the Commission.

 4.8.3 The Committee notes the qualification prescribed for the Secretary of the NMC in the Bill. Keeping in view the importance of the function assigned to the NMC, the Committee recommends that the Secretary should be a person of proven administrative capacity and integrity, possessing a degree in any discipline of medical sciences, and having not less than fifteen years of experience in the administration of medical education and healthcare sectors.

4.8.4 The Committee also recommends that the Secretariat of the Commission shall be headed by a Secretary who shall be the Secretary to the Commission and not a member of the Commission, to be appointed by the Central Government. Accordingly, consequential changes, if any, may be made in all the clauses to replace the word ‘Member Secretary’ with the word ‘Secretary’.

4.8.5 Subject to the above recommendations, the Clause is adopted.

 This clause provides for the procedure of convening of meetings of the NMC, its Chairperson, quorum and other ancillary matters connected to meetings. The Commission shall meet at least once every quarter.

 4.9.3      On the issue of appellate jurisdiction over the decisions taken by the Commission, the Committee is of the view that giving the appellate jurisdiction to the Central Government does not fit into the constitutional provision for separation of powers. The Committee, therefore, recommends constitution of a Medical Appellate Tribunal comprising of a Chairperson, who should be a sitting or retired Judge of the Supreme Court or a Chief Justice of a High Court, and two other Members, to have an appellate jurisdiction over the decisions taken by the Commission. One of the Members should have a special knowledge and experience in the medical profession/medical education and the other member with an experience in the field of health administration at the level of Secretary to Government of India. Consequent changes for replacing the Central Government with the said Tribunal may be reflected in all the subsequent clauses viz. clause 28(6), clause 30(5), clause 34(7), clause 35(3) or any other related clause of the Bill.

 This clause provides for powers and functions of the Commission including:- (a) formulation of policies and framing of guidelines for ensuring high quality and standards in medical education and research; (b) Coordination of functioning of the Commission, Autonomous Boards and State Medical Councils; (c) formulation of policy for regulation of medical profession; (d) power to delegate and form sub-committees.4.10.6     The Committee notes that there was no provision to regulate fees in the Indian Medical Council Act. Thus the provision of regulating fees is a step in the right direction. The Committee also notes that all States in the country have a well defined process to regulate fees charged by the private medical colleges as per their separate State Acts under the existing fee regulatory mechanism. The Committee, therefore, recommends that the existing fee regulatory mechanism for private medical colleges by the States to protect their rights to regulate fees, should not be diluted.

4.10.7     Further, the Committee understands that the fee charged by several unregulated private medical colleges, the deemed universities and the deemed-to-be universities is not regulated under any existing mechanism. In this regard, the Committee recommends that to remove discrepancies it may be ensured that the fee charged by all such unregulated private medical colleges, the deemed universities and the deemed-to-be universities should be regulated at least for 50% of their seats.

4.10.8     Subject to the above recommendation, the clause is adopted.

 4.13    This clause provides for meetings and quorum of Medical Advisory Council.

 4.13.3 The Committee observes that the quorum of 15 members for meetings of the Medical Advisory Council is not only inadequate but also signifies lop sided approach. Hence, the Committee recommends that the quorum should be fifty percent of the Members of the Council. Further the Committee also recommends that the Council should meet at least twice a year at such time and place as may be decided by the Chairman.

4.13.4 Subject to the above recommendation, the clause is adopted.

 4.14   This clause provides for uniform National Eligibility-cum-Entrance Test and counseling for admission in undergraduate course in medical institutions.

 4.14.3 The Committee observes that during the common counseling process, there is utter confusion amongst the various stakeholders including parents & respective medical colleges and as a result many seats remain vacant. The Committee, therefore, recommends that the designated authority of the Central Government, as proposed in the Bill shall conduct the common counseling for All India seats and the designated authority of the State Government shall conduct the common counseling for the seats at the State Level. The Committee also recommends that autonomy to universities/medical institutions as per the provisions of their respective Acts, to which such medical institutions are affiliated, should also be given alongwith the permission to conduct the common counseling. This permission should, however, be for the vacant seats remaining after the National & State level counseling and should be done on merit basis from the candidates who have qualified NEET, so as no vacant seats remain. Similar changes may be made in clause 15 (5) so that no seats remain vacant for Post Graduates also.

4.14.4 Subject to the above recommendations, the Clause is adopted.

 4.15   This clause provides that National Licentiate Examination for students graduating from the medical institutions for granting licence to medical practice, enrolment and admission to postgraduate medical courses.

 4.15.6 The Committee in its 92nd Report had recommended to introduce a common exit test for MBBS doctors as an instrument of quality assurance, and to ensure that the quality and competencies of a doctor, before one starts practicing, are guaranteed and standardized. The Committee held a detailed discussion on the issue of the National Licentiate Examination in view of the suggestions of the stakeholders. The clause 15 mandates a uniform National Licentiate Examination for students graduating from the medical institutions governed by the proposed NMC Act. A three year grace period has been provided for the NLE to be operational. The Committee has taken note of the concerns expressed by various experts and stakeholders regarding the advisability of introducing the NLE at this stage.

4.15.7 The Licentiate exam is proposed to be compulsory for any MBBS doctor to make him eligible to practice medicine. The Committee, however, observes that unless the NLE is carefully designed, there is apprehension that a sizeable number of MBBS doctors who have passed their university level examinations, may be debarred from practice on disqualifying NLE. This will not only undermines the sanctity of the examinations conducted by various universities but also put an extra pressure on the system when the country is already facing a shortage of doctors. This will create a dichotomy where the university certifies a doctor as fit to practice and the failure to qualify NLE exam renders him unfit to practice. It is obvious that the implementationproblem will be huge and the country will, over a period of time, have a population of mismatched unhappy doctors, who have nowhere to go.

4.15.8 The above analysis leads the Committee to the conclusion that the NLE will put undue stress on students, especially those who come from backward sections of the society and States, who cannot afford private guidance/tuitions for NLE and may not be able to crack the Multiple Choice Questions (MCQs).

4.15.9 Taking all the above factors into account, the Committee recommends that the Licentiate examination be integrated with the final year MBBS examination and be conducted at the State Level. The final MBBS examination should be of a common pattern within a particular State, initially due to the logistical constraints, and could be extended across the country as the system streamlines. The Committee also recommends that the final year MBBS exam should be designed in such a way that it takes into consideration not only the cognitive domain but also the assessment of skills by having practical problems/case study types of questions as a major component, with a strong tilt towards primary healthcare requirements.

4.15.10         The Committee further observes that the theoretical examination should be a common short-question based examination for all final professional students at a level commensurate with the current final professional theory examination. The examiners for conducting the practical examinations should be external and to be decided through a lottery from an empanelled list of examiners. The Committee is of the considered view that making provision for the final year MBBS examination as the Licentiate Examination would test both the theoretical and clinical aptitude of the students. The Committee, therefore, recommends that the final year MBBS examination be considered as the Licentiate Examination.

4.15.11         Further, the Committee is of the strong view that if PG entrance and licentiate examination are combined, the students will concentrate only on performing in entrance examination, during their undergraduate days and internship. The Committee, therefore, recommends that the PG NEET for admission to PG courses may continue as of now as an interim management till a mechanism is evolved within three to five years for the conduct of a common final year MBBS examination which has an adequate structure, so that subjectivity in the theoretical examination is replaced by common problem/case study based MCQ type examination. The common final year MBBS examination may be conducted within a particular State by any State University/State Health University or any other suitable agency.

4.15.12         The Committee also observes that the NLE has also been proposed to serve as an instrument for post-graduate entrance. The Committee is of the view that a licentiate exam is a good instrument to maintain a minimum standard across all graduates. The  Committee, however, is of the firm view that to use the same instruments for merit ranking for post-graduate entrance may not serve the purpose because a qualifying examination and a rating examination should not preferably be equated. The Committee, accordingly, recommends that necessary modifications may be made in the above clause to address its above mentioned concerns.

4.15.13         Further, the Committee fails to understand as to how the MBBS students passing out from AIIMS, JIPMER and such other institutions on which NMC Act will not be applicable, will be allowed to get registered in theState/National Register or get admission into postgraduate courses in other medical institutions, without qualifying the NLE. In this regard, the Committee notes the views of the Government and recommends for inclusion of other medical institutions established by separate Act of Parliament in clause 15(1). The Committee also recommends suitable changes in the clause 15(5) to incorporate such medical institutions for conducting common counseling for admission to the postgraduate courses.

4.15.14         Subject to the above recommendations, the clause is adopted.

 4.17    This clause provides for composition of Autonomous Boards consisting of the President and two Members. The second Member of Medical Assessment and Rating Board and Ethics and Medical Registration Board shall be from non- medical background.

 4.17.4 The Committee notes the detailed functions of each Board and observes that their composition is too small for their mandate. Each Autonomous Board will have only three members and most of the work related to medical education and setting up of professional standards are proposed to be done by these Boards. The Committee feels that just three members taking the decisions on such an important subject would not only limit the spectrum of views but also restrict an alternative thinking process within the Boards. The Committee, therefore, recommends that the strength of all the autonomous Boards should be enhanced to five instead of three i.e. a President and four members.

4.17.5 The Committee also recommends that one member in each of the autonomous boards should be an elected member from amongst the nine elected members as recommended by the Committee in the clause 4(4)(c) in context of composition of the NMC. The Committee further recommends that all the members in the Under Graduate Medical Education Board, the Post Graduate Medical Education Board and the Medical Assessment and Rating Board including their President should be from a discipline of medical sciences from any University and having experience of not less than fifteen years in such field, out of which at least seven years shall be as a leader in the area of medical education, public health, community medicine or health research, except the elected member.

4.17.6 The Committee finds merit with the contention of several stakeholders emphasizing the need for an independent tribunal/Board so thatimpartiality is maintained to regulate professional conduct and to promote medical ethics in accordance with the regulations made under this Act. The Committee with its considered view recommends that the President of the Ethics and Medical Registration Board (EMRB) should be a retired Judge of a High Court so as to meet the said objective.

4.17.7 As regards the Members of the EMRB, the Committee reiterates its recommendation for increasing the strength of the Board from three to five. The Committee also recommends two members of the EMRB would remain the same as prescribed in clause 17 of the Bill. The Committee further recommends that out of the remaining two members, one member should be having an experience in the field of law/academics/eminent educationist, of not less than fifteen years and another one member should be an elected member from amongst the nine elected members as recommended by the Committee in the clause 4(4)(c) in context of composition of the NMC. The EMRB shall be independent of the NMC and to avoid any conflict of interest, the Committee recommends that its President should not be a member of the NMC so as to maintain its autonomy and independent character.

4.17.8 Subject to the above recommendations, the Clause is adopted.

 4.24   This clause provides for powers and functions of Under-Graduate Medical Education Board including determination of standards of medical education at undergraduate level, framing of guidelines for establishment of medical institutions for imparting undergraduate medical courses, granting of recognition to medical institutions at undergraduate level.

 4.24.4 The Committee considered the suggestions made by the stakeholder and recommends that clause 24(1)(c) may be amended as follows:- “develop competency based dynamic curriculum for addressing the needs of primary health services, community medicine and family medicine to ensure healthcare in such areas, in accordance with provisions of the regulations made under this Act. “

 4.25   This clause provides for powers and functions of Post-Graduate Medical Education Board including determination of standards of medical education at postgraduate and super-specialty level, framing of guidelines for establishment of medical institutions for imparting postgraduate and super-specialty medical courses, granting of recognition to medical institutions at postgraduate and super- specialty level.

 4.25.2 The Committee considered the suggestions of the stakeholders and recommends that the following new sub-clause may be inserted in clause 25(1) ‘mandate that Institutions that are running post-graduate courses in medical and surgical specialties pediatrics, obstetrics and gynecology shall be required to establish and run post-graduate courses in family medicine as per the regulations prescribed by the Commission.’

4.25.3 The Committee considered the views of the stake holders and accordingly recommends with reference to Clause 25 (1) & 25(2) that suitable provisions may be made to ensure that the shortage of Post Graduate Doctors, Specialists and Faculty is addressed on an emergent basis within the country without compromising the quality as per globally accepted best practises with innovations in clinical teaching methodology.

4.25.4 Subject to the above recommendation, the clause is adopted.

 4.26   This clause provides for powers and functions of Medical Assessment and Rating Board including determine the procedure for assessing and rating of medical institutions for compliance with prescribed standards, granting of permission for establishment of new medical institutions and carrying out of inspection for this purpose, imposing of monetary penalty on medical institution for failure to maintain minimum essential standards prescribed.

 4.26.4 While deliberating on the functions of MARB, the Committee is of the view that for determining the procedure for assessing and rating the medical institutions for their compliance under clause 26(1)(a), the words ‘as the case may be’ to be replaced by ‘using an outcome-based model of regulation that focuses on the outcomes of training rather than the infrastructure, staffing and processes’ in line 39 of the page 11 of the Bill.

4.26.5 While taking note of the provisions made in clause 26(1)(f), regarding the exorbitant monetary penalty which is likely to be imposed in case there is any violation by any medical institution, the Committee observes that monetary penalty introduced in the present system provides for discretionary misuse. This Clause provides for three opportunities to pay the penalty and then recommendations to the Commission to withdraw recognition, which can be further appealed in the mentioned Commission.  The Committee, however, apprehends that during that period of time, 3 to 4 batches of undergraduate students would have got admitted and as known standard of education in these colleges are low and the students who had to select these colleges from NEET would be unnecessarily punished. The Committee, therefore, recommends that all three provisos of Clause 26(f) may be done away with and an alternative provision be made for warning, subsequent reasonable monetary penalty followed by adequate time to address the deficiencies and in case the lacunae still remains a provision for de-recognition for a certain period, subject to adequate check and balances to ensure that there is no misuse of discretionary powers be made.

4.26.6 The Committee further observes that the functions of  MARB have been confined to physical and quantity related parameters. The Committee believes that the MARB needs to include parameters that capture the qualitative changes that have been brought about by medical institutions. These parameters may include (i) rating of the MARB for medical education;

(ii) accreditation of the hospital facilities by NABH/NABL; (iii) contribution in the field of public health in the region where the college is located; (iv) research publications in reputed journals; (v) contribution as a regional training centre; etc.

4.26.7 Subject to the above recommendations, the Clause is adopted.

 4.27   This clause provides for powers and functions of Ethics and Medical Registration Board including maintenance of a National Register for all licensed medical practitioners and regulate professional conduct, to develop mechanism for continuous interaction with State Medical Councils.

 4.27.1 The Committee is constrained to observe that there is no specific data regarding the availability of doctors, nurses, para-medical staffs, mid level health care workers and other allied professionals. Without this data base it is extremely difficult to have a long term planning to manage this human resource component which is critical to achieve the stated targets of health and wellness centres across the country by the Government. The Committee, while taking stock of the powers and functions of Ethics and Medical Registration Board, strongly recommends that the EMRB board may keep an Aadhar linked data base of all medical graduates in the countryincluding their employment status so that an authentic data base of the availability of this important human resource is made and they can be given a choice to opt for rural posting wherever there is a deficit in the country.

4.27.2 The Committee further recommends that a process of registration leading to the creation of a common data base of all human resource working in the healthcare sector including the para-medical staff, nurses etc. may be explored and maintained by EMRB.

4.27.3 Subject to above recommendations, the Clause is adopted.

 4.28   This clause provides for permission for establishment of new medical college.

 4.28.3 The Committee takes into account suggestions from stakeholder that respective State Governments should be given adequate powers for establishment of a new medical college. Due diligence with respect to financial resources, academic faculty, hospital facilities etc. should be left to the State Government concerned that would be in a better position to assess them. The Committee is of the view that prior permission would not be an essentiality but would be needed consequent to the recommendation of the State Government. The Committee, therefore, recommends that to encourage setting up of new medical institutions of higher standard, those medical professional who have been instrumental in setting up of medical colleges from the scratch, may be given due weightage. Consequently, the Committee, in this regard, strongly recommends for re-drafting of Clause 28(1) of the Bill so as to provide adequate opportunity to the State Government in the decision making process with regard to establishment of the new medical colleges.

4.28.4 The Committee also takes into consideration the suggestions made by a stakeholder in Clause 28(7) and agrees that evaluation or assessment of any University or medical institution should be done only by well qualified and eligible medical professional of highest integrity with a proven track record. The Committee, therefore, strongly recommends to incorporate the words ‘of unquestionable integrity having experience of medical profession’ after ‘any other expert’ as mentioned in line 16-17 of page 13 of the Bill. The Committee also recommends for a hundred member panel of experts to be selected as assessors by NMC keeping in view the large size of the country. The deputation of assessors out of these hundred experts would be done by MARB through a process of lottery/draw for carrying out the inspection of medical colleges.

4.28.5 Subject to above recommendations, the Clause is adopted.

 4.29   This clause provides for criteria for approval or disapproval of the scheme for establishment of new medical college.

 4.29.3 With respect to clause 29, the Committee recommends that the State Governments concerned shall undertake the required assessment and rating under clause 29(a) to (d), prior to the submission of a new proposal for setting up of a medical college to MARB.

4.29.4 The Committee also recommends to put in place a mechanism wherein adequate hospital facilities at the commencement of a medical college is mandatory. Hospitals with adequate facilities and providing clinical services for at least three years may only apply for the establishment of a new medical college resulting in better trained doctors with adequate clinical exposure.

4.29.5 Subject to above recommendations, the Clause is adopted.

 4.31   This clause provides for the maintenance of a National Register by Ethics and Medical Registration Board which shall contain the name, address and all recognised qualifications possessed by licensed medical practitioner. Every State Medical Council shall maintain a State Register. The registers will be maintained in such forms including electronic form as may be specified. A separate National Register shall be maintained for AYUSH practitioners who qualifies bridge course in modern medicine.

4.31.2 Subject to the recommendations of the Committee contained in clause 27 and clause 49, the clause is adopted.

4.32   This clause provides for rights of persons to have licence to practice and to be enrolled in National Register or State Register. A person who qualifies National Licentiate Examination shall be enrolled in the National Register or State Register.

 4.32.3 After detailed deliberations, the Committee came to the conclusion that Clause 32(1) the words any person who qualifies the National Licentiate Examination, as mentioned in line 45 (page 14 of the Bill) may be substituted by the words any person who qualifies the final year MBBS examination. The Committee, accordingly, recommends to re-draft the Clause so as to make the final year MBBS examination as the licentiate examination.

4.33    This clause provides for bar to practice. A person who is not enrolled in the State or National Register shall not be allowed to practice medicine or perform any of the function enrolled upon a qualified medical practitioner such as holding an office of physician or surgeon, signing a medical certificate or giving evidence in matters related to medicine. Any violation shall be punishable with fine to the tune of Rs. one to five lakhs. The Commission may permit exceptions from qualifying National Licentiate Examination in certain cases. Foreign medical practitioners shall be permitted temporary registration in India in such manner as may be prescribed.

 Committees Observations/recommendations

4.33.3 The Committee takes into account the response of the Government vis-a-vis the suggestions received on this Clause. The Committee is of the view that there are no cogent reasons to wave off the requirement of NLE as specified in the first proviso to Clause 33(1)(d), in line 23 to 25 of page 15 of the Bill, which gives discretionary powers to the Central Government to allow those who have failed in the Licentiate Exam to practice medicine or perform surgery. The Committee therefore, strongly recommends to delete the first proviso of Clause 33(1)(d) of the Bill.

4.33.4 The Committee also deliberated on the third proviso of Clause 33(1)(d) and recommends that a foreign citizen, who is enrolled in his country as a medical practitioner in accordance with the law, may be permitted to practice medicine and surgery subsequent to qualifying the screening test meant for foreign medical graduates. However, highly qualified and renowned medical professionals from countries that are accredited by the National Medical Commission may be permitted to obtain temporary registration in India without going through the screening process.

4.33.5 On Clause 33(2), the Committee is of the view that persons, who contravene any of the provisions regarding bar to practice, shall be penalised with harsher punishment. Accordingly, the Committee recommends insertions of penal provisions under appropriate Sections of the Code of Criminal Procedure, 1973. The Clause may accordingly be re-drafted to incorporate those provisions.

4.33.6 Subject to the above recommendations, the Clause is adopted.

 4.35   This clause provides for recognition of medical qualifications granted by medical institutions outside India.

 4.35.3 On the issue of recognition of medical qualification granted by medical institutions outside India, this Clause provides that the NMC may, subject to certain verification, either grant or refuse to grant recognition to that medical qualification. In this regard, the Committee recommends that the discretion of NMC should be subject to qualifying the screening test (FMGE) meant for foreign medical graduates.

 4.36   This clause provides for recognition of medical qualifications granted by statutory or other bodies in India which are covered by the categories listed in the Schedule.

 4.36.5 The Committee notes that India has two parallel systems of Post Graduate Medical Education i.e. MD and DNB. The Committee recommends that the Diplomate of National Board, granted by the National Board of Examinations, in broad specialty course and super-specialty course shall be equal in all respects to the post-graduate qualification and the super-specialty qualification, respectively, as granted under this Act with the exception in teaching in medical colleges as they do not take DNB education in a medical college. With the coming into force of this Act, all the post-graduate education programmes being conducted by the National Board of Examinations will be brought under the purview of the Commission for award of common degrees.

4.36.6 Subject to above recommendation, the Clause is adopted.

 4.39       This clause provides for special provisions in certain cases for recognition of medical qualifications. This relates to medical institutions outsideIndia.

 4.39.3               The Committee recommends that any medical qualification granted by the medical institution outside India shall be recognized medical qualifications for the purpose of this Act subject to qualifying the screening test (FMGE) meant for foreign medical graduates.

 4.45       This clause provides for power of the Central Government to give directions to State Governments.

 4.45.3    The Committee observes that Clause 45 gives absolute powers to the Central Government to issue directions to the State Government. The Committee was given an impression by various stakeholders that the said provision of clause 45 is against the spirit of cooperative federalism. The Committee in this regard recommends that the Central Government may give only such policy directions, as it may deem necessary, to State Government for carrying out all or any of the provisions of this Act.

4.49       This clause provides for joint sittings of the Commission, Central Councils of Homoeopathy and Indian Medicine to enhance interface between their respective systems of medicine. Such meeting shall be held at least once a year. The joint sitting may decide on approving educational modules to develop bridges across the various systems of medicine and promote medical pluralism.

 4.49.9            The Committee is of the view that the bridge course should not be made a mandatory provision in the present Bill. However, the Committee appreciates the need to build the capacity of the existing human resources in the healthcare sector, to address the shortage of healthcare professionals so as to achieve the objectives of the National Health Policy, 2017. The Committee feels that every State has its own specific healthcare issues and challenges. The Committee, therefore, recommends that the State Governmentsmay implement measures to enhance the capacity of the existing healthcare professionals including AYUSH practitioners, B.Sc (Nursing), BDS, B.Pharmaetc to address their State specific primary healthcare issues in the rural areas. The Committee also recommends that adequate budgetary resources may also be provided to meet the saidobjective.

4.49.10      The Committee recommends that the healthcare professionals who are practicing without the requisite qualifications anywhere in the country may attract penalprovisions.

4.49.11     Accordingly, consequential changes may be made in all the Clauses of the Bill, wherever applicable Subject to above recommendations, the Clause is adopted.4.58       This clause provides for repeal and saving. The Indian Medical Council Act, 1956 shall stand repealed and the Medical Council of India shall stand dissolved from the date as may be prescribed by the Central Government. The Chairman and other Members and employees of Medical Council of India shall vacate their respective offices and be entitled to the compensation.

 4.58.3                The Committee is of the view that this provision of the Bill intends to remove all the employees & staff of MCI after it will be dissolved does not seem to be fair and is against the principles of natural justice. Such a move would mean inhuman treatment meted out to the employees whose services would be terminated once the MCI gets dissolved. The Committee, therefore, recommends that instead of termination of their services, the employees of Group B, C and D category of the council may be suitably absorbed on compassionate grounds in any Department of the Government.

4.59.4          Subject to above recommendations, the Clause is adopted.

 Clause I, Enacting Formula, Preamble and Title

4.60      This clause provides for short title, extent and commencement of the proposedAct.

 4.60.3               A preamble is an introductory and expressionary statement in a document that explains the document’s purpose and its underlying philosophy and also recites historical facts pertinent to the subject of the statute. But, the Committee notes that the Preamble of the NMC Bill suffers from certain major infirmities.  The Committee observes that the Preamble fails to mention safeguarding patient safety, promoting ethics and achieving national health goals. The Committee is of the considered view that the Preamble of the Bill that set outs the objectives must contain provisions on protecting, promoting and maintaining the health safety and well being of the public, maintaining proper professional standards, enforcing ethical conduct and standards by medical professionals in all aspect of medical services, including affordable medical care and adequate & high quality medical education that must encourage community health perspective/service of medical profession.

4.60.4    The Committee, therefore, recommends that the Preamble to the Bill may be amended as follows after due legislative vetting:-

‘to provide for a medical education system that improves access to quality and affordable medical education, ensures availability of adequate and high quality medical professionals in all parts of the country; that promotes equitable and universal healthcare that encourages Community Health Perspective and makes services of Medical Professionals accessible to all the citizens; that promote national health goals; that encourages medical professionals to adopt latest medical research in their work and to contribute to research; that has an objective periodic and transparent assessment of medical institutions and facilitates maintenance of a medial register for India and enforces high ethical standards in all aspects of medical services; that is flexible to adapt to changing needs and has an effective grievance redressal mechanism and for matters connected therewith or incidental thereto.’

4.60.5               The Committee also recommends consequential change in the Title of the Bill, i.e, ‘The National Medical Commission Bill, 2018’, instead of

‘The National Medical Commission Bill, 2017’ and ‘Sixty-ninth Year’ instead of ‘Sixty-eighth Year’.

4.60.6               Subject to the above recommendations, clause I, the Enacting Formula, Preamble and the Title are adopted.

4.61                   The Committee strongly recommends for adding a separate provision in the Bill stating asunder:

‘Notwithstanding anything contained in any law, the provisions of this Act and subsequent rules & regulations made therein shall be uniformly applicable upon all medical institutions in the country without any distinction, unless specifically mentioned in the Act.’

4.61.1            The Committee also recommends for all consequential changes to be carried out in the relevant clauses of the Bill keeping in view the Committee’s observations and recommendations contained in thereport.

CHAPTER – V GENERAL RECOMMENDATIONS

5.              The Committee observes that there had been a loss of credibility of the existing regulatory body i.e MCI. The Committee, therefore, recommends that all the Members of the National Medical Commission be required to mandatorily declare their professional and commercial involvements and should also declare their personal assets along with assets of their dependents on the website of NMC as and when they assume office and at the end of their tenure.

5.1 The Committee observes that medical health care system encompasses health professionals working in the area of para medical disciplines like physiotherapy, optometry and other allied fields where there is n