The Tribunals Reforms Bill, 2021 was introduced in Lok Sabha today.  It seeks to dissolve certain existing appellate bodies and transfer their functions (such as adjudication of appeals) to existing judicial bodies (mainly high courts) (see Table 1).  It also amends the Finance Act, 2017, to bring certain provisions (such as qualifications, appointments, term of office, salaries and allowances of tribunal members) under the purview of the Bill.  Currently, these provisions are notified through Rules under the Finance Act, 2017.   

Note that the 2017 Act reorganised the Indian tribunal system to ensure uniformity in their administration by amalgamating certain tribunals based on the similarity in their functional domain.  It also delegated powers to the central government to make Rules to provide for the qualifications, appointments, term of office, salaries and allowances, removal, and other conditions of service for chairpersons and members of these tribunals.  

This Bill replaces an Ordinance with similar provisions that was promulgated in April 2021.   The 2021 Ordinance was challenged in the Supreme Court over its compliance with past Supreme Court judgements.  In July 2021, the Court struck down certain provisions of the Ordinance, such as the four-year term of office for members, and the minimum age bar of 50 years to be appointed as a member of a tribunal.  Table 2 shows a detailed comparison of key provisions of the 2021 Bill with the 2021 Ordinance and the principles laid down by the Supreme Court in its judgement.  The Bill does not conform to the judgement of the Supreme Court and retains the provisions of the Ordinance that were struck down by the Court. 

For an analysis of the 2021 Ordinance, please see our note here.  For more details on the evolution of the tribunal system in India, please see our note

Table 1: Transfer of functions of key appellate bodies as proposed under the Bill

Appellate body

Role

Proposed entity

Appellate Tribunal under the Cinematograph Act, 1952

Adjudication of appeals against the Board of Film Certification

High Court

Appellate Board under the Trade Marks Act, 1999

Adjudication of appeals against orders of the Registrar

High Court

Appellate Board under the Copyright Act, 1957

Adjudication of certain disputes and appeals against orders of the Registrar of Copyright.   Disputes include those related to publications and term of the copyright

Commercial Court or the Commercial Division of a High Court*

Authority for Advance Rulings under the Customs Act, 1962

Adjudication of appeals against orders of the Customs Authority for advance rulings

High Court

Appellate Board under The Patents Act, 1970

Adjudication of appeals against decisions of the Controller on certain matters.  Matters include applications for patents and restoration of patents.

High Court

Airport Appellate Tribunal under the Airports Authority of India Act, 1994

Adjudication of:

  • disputes arising from the disposal of properties left on airport premises by unauthorised occupants, and
  • for appeals against the order of an eviction officer
  • Central government, for disputes arising from the disposal of properties left on airport premises by unauthorised occupants.
  • High Court, for appeals against orders of an eviction officer.

Airport Appellate Tribunal under the Control of National Highways (Land and Traffic) Act, 2002

Adjudication of appeals against orders of the Highway Administration on matters including, grant of lease or licence of highway land, removal of unauthorised occupation, and prevention of damage to highway.

Civil Court# 

Appellate Tribunal under the Protection of Plant Varieties and Farmers' Rights Act, 2001

Adjudication of appeals against certain orders of Registrar or Plant Varieties and Farmer Rights Authority

High Court

Appellate Board under the Geographical Indications of Goods (Registration and Protection) Act, 1999

Adjudication of appeals against orders of the Registrar

High Court

Notes: * Constituted under the Commercial Courts Act, 2015; # Refers to a Civil Court of original jurisdiction in a district and includes the High Court in the exercise of its ordinary original civil jurisdiction.
Sources: The Tribunals Reforms Bill, 2021; Parent Acts of the appellate bodies; PRS.

Table 2: Key provisions in the 2021 Bill and the Ordinance vis-a-vis the Supreme Court judgements

Provisions

2021 Ordinance

Supreme Court Judgement of July 2021

2021 Bill

Term of office of Chairperson and members

Four-year term with eligibility for re-appointment.

The Court stated that a short tenure of members (such as three years) along with provisions of re-appointment increases the influence and control of the Executive over the judiciary.  In a short tenure, by the time the members achieve the required knowledge, expertise and efficiency, one term gets over.  This prevents enhancement of adjudicatory experience, thereby, impacting the efficacy of tribunals.

The Court struck down the provision of four -year term and reiterated its past judgements, which recommended a five-year term with eligibility for re-appointment.  

Same as that in Ordinance.

Minimum age requirement for appointment of Chairperson and members

50 years

The Court observed that the minimum age requirement of 50 years violates past Court judgements, where the Court has stated that advocates with at least 10 years of relevant experience must be eligible to be appointed as judicial members, as that is the qualification required for a High Court judge.  Such a high age limit also prevents the recruitment of young talent.

The provision was struck down.

Same as that in Ordinance.

Time limit for appointments

Preferably within three months from the date of the recommendations of the search-cum-selection committee.

The Court noted that not mandating the central government to make appointments within three months (from the date of recommendation of the search-cum-selection committee) leads to delay in the appointment of members.  This impacts the functioning and efficacy of tribunals.

The provision was struck down over non-compliance with past judgements, which mandated the appointments to be made within three months.

Same as that in Ordinance.

Number of recommendations for a post

Two names for each post.

The Court stated that the recommendations for appointment of members by the search-cum-selection committee should be final.  The Executive must not be allowed to exercise any discretion in matter of appointments in a tribunal.

The Court struck down the provision and reiterated its past judgement, which specified that the selection committee must suggest one name for each post.  The Committee may recommend one name in wait list.  

Same as that in Ordinance.

Sources: The Tribunals Reforms Ordinance, 2021; The Tribunals Reforms Bill, 2021; Madras Bar Association vs Union of India, W.P.(C) No. 000502 of 2021; PRS.

Today, the National Medical Commission Bill, 2019 was passed by Lok Sabha.  It seeks to regulate medical education and practice in India.  In 2017, a similar Bill had been introduced in Lok Sabha.  It was examined by the Standing Committee on Health and Family Welfare, which recommended several changes to the Bill.  However, the 2017 Bill lapsed with the dissolution of the 16th Lok Sabha.  In this post, we analyse the 2019 Bill.

How is medical education and practice regulated currently?

The Medical Council of India (MCI) is responsible for regulating medical education and practice.  Over the years, there have been several issues with the functioning of the MCI with respect to its regulatory role, composition, allegations of corruption, and lack of accountability.  For example, MCI is an elected body where its members are elected by medical practitioners themselves, i.e., the regulator is elected by the regulated.  Experts have recommended nomination based constitution of the MCI instead of election, and separating the regulation of medical education and medical practice.  They suggested that legislative changes should be brought in to overhaul the functioning of the MCI.

To meet this objective, the Bill repeals the Indian Medical Council Act, 1956 and dissolves the current MCI.

The 2019 Bill sets up the National Medical Commission (NMC) as an umbrella regulatory body with certain other bodies under it.  The NMC will subsume the MCI and will regulate medical education and practice in India.  Under the Bill, states will establish their respective State Medical Councils within three years.  These Councils will have a role similar to the NMC, at the state level.

Functions of the NMC include: (i) laying down policies for regulating medical institutions and medical professionals, (ii) assessing the requirements of human resources and infrastructure in healthcare, (iii) ensuring compliance by the State Medical Councils with the regulations made under the Bill, and (iv) framing guidelines for determination of fee for up to 50% of the seats in the private medical institutions.

Who will be a part of the NMC?

The Bill replaces the MCI with the NMC, whose members will be nominated.  The NMC will consist of 25 members, including: (i) Director Generals of the Directorate General of Health Services and the Indian Council of Medical Research, (ii) Director of any of the AIIMS, (iii) five members (part-time) to be elected by the registered medical practitioners, and (iv) six members appointed on rotational basis from amongst the nominees of the states in the Medical Advisory Council.

Of these 25 members, at least 15 (60%) are medical practitioners.  The MCI has been noted to be non-diverse and consists mostly of doctors who look out for their own self-interest over public interest.   In order to reduce the monopoly of doctors, it has been recommended by experts that the MCI should include diverse stakeholders such as public health experts, social scientists, and health economists.  For example, in the United Kingdom, the General Medical Council which is responsible for regulating medical education and practice consists of 12 medical practitioners and 12 lay members (such as community health members, administrators from local government).

What are the regulatory bodies being set up under the NMC?

The Bill sets up four autonomous boards under the supervision of the NMC.  Each board will consist of a President and four members (of which two members will be part-time), appointed by the central government (on the recommendation of a search committee).  These bodies are:

  • The Under-Graduate Medical Education Board (UGMEB) and the Post-Graduate Medical Education Board (PGMEB): These two bodies will be responsible for formulating standards, curriculum, guidelines for medical education, and granting recognition to medical qualifications at the under-graduate and post-graduate levels respectively.
  • The Medical Assessment and Rating Board: The Board will have the power to levy monetary penalties on institutions which fail to maintain the minimum standards as laid down by the UGMEB and the PGMEB.  It will also grant permissions for establishing new medical colleges, starting postgraduate courses, and increasing the number of seats in a medical college.
  • The Ethics and Medical Registration Board: This Board will maintain a National Register of all the licensed medical practitioners in the country, and also regulate professional and medical conduct.  Only those included in the Register will be allowed to practice as doctors.  The Board will also maintain a register of all licensed community health providers in the country.

How is the Bill changing the eligibility guidelines for doctors to practice medicine?

There will be a uniform National Eligibility-cum-Entrance Test for admission to under-graduate and post-graduate super-speciality medical education in all medical institutions regulated under the Bill.  Further, the Bill introduces a common final year undergraduate examination called the National Exit Test for students graduating from medical institutions to obtain the license for practice.  This test will also serve as the basis for admission into post-graduate courses at medical institutions under this Bill.  Foreign medical practitioners may be permitted temporary registration to practice in India.

However, the Bill does not specify the validity period of this license to practice.  In other countries such as the United Kingdom and Australia, a license to practice needs to be periodically renewed.  For example, in the UK the license has to be renewed every five years, and in Australia it has to renewed annually. 

How will the issues of medical misconduct be addressed?

The State Medical Council will receive complaints relating to professional or ethical misconduct against a registered medical practitioner.  If the medical practitioner is aggrieved of a decision of the State Medical Council, he may appeal to the Ethics and Medical Registration Board.  If the medical practitioner is aggrieved of the decision of the Board, he can approach the NMC to appeal against the decision.  It is unclear why the NMC is an appellate authority with regard to matters related to professional or ethical misconduct of medical practitioners. 

It may be argued that disputes related to ethics and misconduct in medical practice may require judicial expertise.  For example, in the UK, the regulator for medical education and practice – the General Medical Council (GMC) receives complaints with regard to ethical misconduct and is required to do an initial documentary investigation in the matter and then forwards the complaint to a Tribunal.  This Tribunal is a judicial body independent of the GMC.  The adjudication decision and final disciplinary action is decided by the Tribunal.

How does the Bill regulate community health providers?

As of January 2018, the doctor to population ratio in India was 1:1655 compared to the World Health Organisation standard of 1:1000.  To fill in the gaps of availability of medical professionals, the Bill provides for the NMC to grant limited license to certain mid-level practitioners called community health providers, connected with the modern medical profession to practice medicine.  These mid-level medical practitioners may prescribe specified medicines in primary and preventive healthcare.  However, in any other cases, these practitioners may only prescribe medicine under the supervision of a registered medical practitioner.

This is similar to other countries where medical professionals other than doctors are allowed to prescribe allopathic medicine.  For example, Nurse Practitioners in the USA provide a full range of primary, acute, and specialty health care services, including ordering and performing diagnostic tests, and prescribing medications.  For this purpose, Nurse Practitioners must complete a master's or doctoral degree program, advanced clinical training, and obtain a national certification.