The Medical Council of India (MCI) has seen a few major controversies over the past decade. In the latest incident, MCI President, Dr. Ketan Desai was arrested by the CBI on charges of accepting a bribe for granting recognition to Gyan Sagar Medical College in Punjab. Following this incident, the central government promulgated an ordinance dissolving the MCI and replacing it with a centrally nominated seven member board. The ordinance requires MCI to be re-constituted within one year of its dissolution in accordance with the provisions of the original Act. Background The Medical Council of India was first established in 1934 under the Indian Medical Council Act, 1933. This Act was repealed and replaced with a new Act in 1956. Under the 1956 Act, the objectives of MCI include:
Over the years, several committees, the most recent being the National Knowledge Commission (NKC) and the Yashpal Committee, have commented on the need for reforms in medical regulation in the country. The Ministry of Health and Family Welfare (MoH&FW) has recently released a draft of the National Council for Human Resources in Health (NCHRH) Bill for public feedback. (See http://mohfw.nic.in/nchrc-health.htm) Key issues in Medical Regulation Oversight Currently, separate regulatory bodies oversee the different healthcare disciplines. These include the Medical Council of India, the Indian Nursing Council, the Dental Council of India, the Rehabilitation Council of India and the Pharmacy Council of India. Each Council regulates both education and professional practice within its domain. The draft NCHRH Bill proposes to create an overarching body to subsume these councils into a single structure. This new body, christened the National Council for Human Resources in Health (NCHRH) is expected to encourage cross connectivity across these different health-care disciplines. Role of Councils Both the NKC and the Yashpal Committee make a case for separating regulation of medical education from that of profession. It is recommended that the current councils be divested of their education responsibilities and that these work solely towards regulation of professionals – prescribing a code of ethics, ensuring compliance, and facilitating continued medical education. In addition, it has been recommended that a national exit level examination be conducted. This exit examination should then serve the purpose of ‘occupational licensing’, unlike the prevalent registration system that automatically grants practice rights to graduating professionals. In effect, it is envisaged that the system be reconfigured on the lines of the Institute of Chartered Accountants, wherein the council restricts itself to regulating the profession, but has an indirect say in education through its requirements on the exit examination. A common national examination is also expected to ensure uniformity in quality across the country. Both committees also recommend enlisting independent accrediting agencies for periodically evaluating medical colleges on pre-defined criteria and making this information available to the public (including students). This is expected to bring more transparency into the system. Supervision of education – HRD vs. H&FW The Ministry of Human Resources and Development (MHRD) is proposing a National Council for Higher Education and Research (NCHER) to regulate all university education. However, MoH&FW is of the opinion that Medical Education is a specialized field and needs focused attention, and hence should be regulated separately. However, it is worth noting that both the NKC and the Yashpal Committee recommend transferring education overseeing responsibilities to the NCHER. Internationally, different models exist across countries. In the US, the Higher Education Act, 1965 had transferred all education responsibilities to the Department of Education. In the UK, both medical education and profession continue to be regulated by the General Medical Council (the MCI counterpart), which is different from the regulator for Higher Education. Composition of Councils In 2007-08, MCI, when fully constituted, was a 129 member body. The Ministry in its draft NCHRH Bill makes a case for reducing this size. The argument advanced is that such a large size makes the council unwieldy in character and hence constrains reform. In 2007-08, 71% of the members in the committee were elected. These represented universities and doctors registered across the country. However, the Standing Committee on H&FW report (2006) points out that delays in conducting elections usually leads to several vacancies in this category, thereby reducing the actual percentage of elected members. MCI’s 2007-08 annual report mentions that at the time of publishing the report, 29 seats (32% of elected category) were vacant due to ‘various reasons like expiry of term, non-election of a member, non-existence of medical faculty of certain Universities’. In November 2001, the Delhi High Court set aside the election of Dr. Ketan Desai as President of the MCI, stating that he had been elected under a ‘flawed constitution’. The central government had failed to ensure timely conduct of elections to the MCI. As a result, a number of seats were lying vacant. The Court ordered that the MCI be reconstituted at the earliest and appointed an administrator to oversee the functioning of the MCI until this was done. Several countries like the UK are amending their laws to make council membership more broad-based by including ‘lay-members’/ non-doctors. The General Medical Council in the UK was recently reconstituted and it now comprises of 24 members - 12 ‘lay’ and 12 medical members. (See http://www.gmc-uk.org/about/council.asp) Way ahead According to latest news reports, the MoH&FW is currently revising the draft Bill. Let's wait and see how the actual legislation shapes up. Watch this space for further updates!
There are indications that the Lok Pal Bill, 2011 is likely to be taken up for consideration and passing during the current Winter session of Parliament. The Bill was introduced on Aug 4, 2011 in the Lok Sabha after a prolonged agitation led by Anna Hazare (see PRS analysis of the Bill). It was referred to the Parliamentary Standing Committee on Personnel, Public Grievances, Law and Justice (see PRS note on Committee Systems). The Committee submitted its report on December 9, 2011. The report includes 10 dissent notes from 17 MPs. (a) Kirti Azad, Bal Apte, D.B. Chandre Gowda, Harin Pathak, Arjun Ram Meghwal, and Madhusudan Yadav. (b) Ram Jethmalani (c) Ram Vilas Paswan (d) Shailendra Kumar (e) Prasanta Kumar Majumdar (f) Pinaki Misra (g) A. Sampath (h) S. Semmalai (i) Meenakshi Natrajan, P.T. Thomas, and Deepa Dasmunshi (j) Vijay Bahadur Singh Presently, the government and the Opposition are in the process of formulating their stands on various key issues such as inclusion of the Prime Minister, the lower bureaucracy and the role of the Central Investigation Bureau. We provide a broad overview of the views of the members of the Committee on various key issues. Unanimity on issues On some issues, there was unanimity among the Committee members:
Dissent on issues Certain members of the Committee dissented on specific issues. In Table 1, we list the issues and the reason for the dissent. Table 1: Recommendation of Standing Committee and dissent by individual MPs
| Issues | Standing Committee recommendations | Points of dissent | Dissenting MPs |
| Inclusion of Prime Minister | Committee left the decision to Parliament stating that there are pros and cons to each view. | - PM should be included. - PM should be brought under the Lok Pal with some exceptions for national security, foreign policy, atomic energy etc. - The decision to investigate or prosecute the PM should be taken by the Lok Pal with 3/4th majority. | - Prasanta Kumar Majumdar, A. Sampath. - Kirti Azad etc, Shailendra Kumar, Pinaki Misra. |
| Grievance redressal mechanism | Enact separate law for a grievance redressal mechanism. | Include in the Lok Pal Bill. | Kirti Azad etc, Ram Jethmalani, Shailendra Kumar. |
| Inclusion of bureaucracy | Include Group B officers in addition to Group A. | - Include all groups of govt employees. - Include Group ‘C’. - Do not include bureaucrats. | - Kirti Azad etc, A. Sampath. - Meenakshi Natrajan etc, Shailendra Kumar, Prasanta Kumar. Majumdar, Pinaki Misra, Vijay Bahadur Singh. - Ram Vilas Paswan. |
| Lokayukta | Single, central law to deal with Lok Pal and state Lokayuktas to ensure uniformity in prosecution of public servants. | States should retain power to constitute Lokayuktas. | - S. Semmalai. |
| Private NGOs, media and corporate | Include all entities with specified level of govt control or which receive specified amount of public donations or foreign donations above Rs 10 lakh. | No private organsiations should be included. | - Kirti Azad etc., Ram Vilas Paswan. |
| Composition of search and selection committees | Selection Committee: In addition to PM and Speaker, it should include the Chief Justice of India, an eminent Indian unanimously nominated by the CAG, CEC and UPSC chairman and only Leader of Opposition of Lok Sabha. Search Committee: Mandatory to constitute. Minimum 7 members with 50% members from SC/ST, OBC, minorities and women. | Selection Committee: PM, Minister, LoPs of both Houses, two judges and CVC. Search Committee: CJI, CAG, CEC, Cabinet Secretary, judges of Supreme Court and High Courts. Selection Committee: PM, LoP in the Lok Sabha, one judge of SC and one Chief Justice of a HC, CVC, CEC and CAG. Search Committee: 10 members out of which 5 should be from civil society and 5 should be retired Chief Justice, CVC, CAG and CEC. Half the members to be from SC/STs, OBCs, minorities or women. | - Kirti Azad etc. - Shailendra Kumar. |
| Removal of Lok Pal | In addition to petitioning the President, a citizen should be allowed to approach the Supreme Court directly with a complaint. If admitted, it would be heard by a 5 judge bench. If President does not refer a citizen’s petition, he should give reasons. | Investigation should be conducted by an independent complaint authority. Heavy fines should be imposed in case of a false or frivolous complaint. Instead of the President, the Supreme Court should have power to suspend a member pending inquiry. | - Shailendra Kumar. |
| Role of CVC and CBI | CVC should investigate Group C and D employees. Instead of Lok Pal’s investigation wing, the CBI should investigate cases after inquiry by the Lok Pal. CBI to have autonomy over its investigation. Lok Pal shall exercise general supervision over CBI. | CBI should be under the control of the Lok Pal. The CBI Director should be appointed by the Lok Pal’s selection committee. The CVC should be under Lok Pal and the SVCs under the state Lokayuktas. | - Ram Jethmalani, Shailendra Kumar. - A. Sampath. - Meenakshi Natrajan etc. |
| False and frivolous complaints | Term of imprisonment should be maximum six months. Amount of fine should not exceed Rs 25,000. Specifically provide for complaints made in good faith in line with the Indian Penal Code. | The term of imprisonment should not exceed 30 days. | - Kirti Azad etc. |
| Article 311 | Article 311 of the Constitution should be amended or replaced with a statute. | The procedure adopted by the disciplinary authority should conform to Article 311. | - Kirti Azad etc, Meenakshi Natrajan etc. |
| Finance | Lok Pal Bill states that all expenses of the Lok Pal shall be charged to the Consolidated Fund of India (no need for Lok Sabha clearance). The Committee did not make any recommendation with regard to finances of the Lok Pal. | Lok Pal’s expenses should be cleared by the Parliament. Lok Pal should present its budget directly to Parliament rather than through a ministry. | - Kirti Azad etc. - Shailendra Kumar. |
| Sources: The Lok Pal Bill, 2011; the Department Related Standing Committee Report on the Lok Pal Bill, 2011 and PRS. | |||
