Indian Medical Council: Role as a Regulator

Medical Negligence

The Medical Council of India was established in 1934 under the Indian Medical Council Act, 1933, now repealed, with the main function of establishing uniform standards of higher qualifications in medicine and recognition of medical qualifications in India and abroad.

Section 12 of the Indian Medical Council  Act provides that the MCI can grant recognition of Medical qualifications to the Medical institutions in various countries with which there is a scheme of reciprocity.

1. The Indian Medical council Act, 1956 contains provisions in Sections 12, 13, and 14 with a view to recognizing Medical qualifications granted by Medical insti-tutions in foreign countries.

2. Over a period of time it has come to notice that a large number of private agencies sponsor students for Medical studies in institutions outside India for commercial considerations. Such students also include the students who did not fulfil the minimum eligibility requirements for admission to Medical courses in India. Serious aberrations have been noticed in the standards of Medical education in some of the foreign countries which are not at par with the standards of Medical education available in India. Due to lack of uniformity in the standards of Medical education in various foreign countries, it has been decided that a provision should be made in the Indian Medical council Act, 1956 to enable the Medical council of India to conduct a screening test in order to satisfy itself with regard to the adequacy of knowledge and skills acquired by citizens of India who obtain Medical qualifications from Universities or Medical institutions outside India before they are granted registration to practice medicine in India.

3. Further, issue of prior eligibility certificate by the Medical council of India would ensure that only those candidates who conform to the council norms of admission to the Medical college in India would go for undergraduate Medical education outside India.

The Indian Medical council Act, 1956 was amended by the Indian Medical council (Amendment) Act, 2001 and the said Amendment Act was published in the Official Gazette on 3-9-2001 after receiving the assent of the President of India.

MCI and Medical Education

In exercise of the powers conferred by S. 33 read with S. 20 of the Indian Medical council Act, 1956, the Medical council of India has, with the previous sanction of the Central Government, made the regulations called “the Post-Graduate Medical Education Regulations, 2000” (hereinafter the Regulations, for short). Regulation 9, relevant for our purpose, provides as under :-

9. SELECTION OF POST-GRADUATE STUDENTS

(1) Students for post-graduate Medical courses shall be selected strictly on the basis of their academic merit.

(2) For determining the academic merit, the University/institution may adopt any one of the following procedures both for degree and diploma courses :-

(i) On the basis of merit as determined by a competitive test conducted by the State Government or by the competent authority appointed by the State Government or by the University/group of Universities in the same State; or

(ii) On the basis of merit as determined by a centralized competitive test held at the national level; or

(iii) On the basis of the individual cumulative performance at the first, second and third MBBS examinations, if such examinations have been passed from the same University; or

Provided that wherever entrance test for post-graduate admission is held by a State Government or a University or any other authorised examining body, the minimum percentage of marks for eligibility for admission to post-graduate Medical course shall be 50 per cent. for general category candidates and 40 per cent. for the candidates belonging to Scheduled Castes, Scheduled Tribes and Other Backwad Classes :

Provided further that in non-Government institutions fifty per cent. of the total seats shall be filled by the competent authority and the remaining fifty per cent. by the management of the institution on the basis of merit.

(i) the Indian Medical council Act, 1956, especially the provisions contained in Ss. 16 to 20 of the Act empower the council to prescribe the minimum standards of Medical education required for granting recognised Medical qualifications other than post-graduate Medical qualifications by the Universities or Medical institutions, as also to prescribe the minimum standards of post-graduate Medical education. The Universities must necessarily be guided by the standards prescribed under S. 20(1) if their degrees or diplomas are to be recognised under the Medical council of India Act. An earlier decision of this Court in Ajay Kumar Singh and others vs. State of Bihar and others (1994) 4 SCC 401 taking the view that the standards of post-graduate Medical education prescribed by the Medical council of India are merely directory and the Universities are not bound to comply with the standards so prescribed was overruled (para 55);

(ii) The Medical council Regulations have statutory force and are mandatory. The Act contemplates the Medical council of India having been set up as an expert body to control the minimum standards of Medical education and to regulate their observance. It has implicit power to supervise the qualifications or eligibility standards for admission to Medical institutions. The Medical council has to keep overall vigilance to prevent sub-standard entrance qualifications for Medical courses. These observations apply equally to post-graduate Medical courses (para 57);

(iii) A Common Entrance Examination envisaged under the Regulation framed by the Medical council of India for post-graduate Medical education requires the fixing of minimum qualifying marks for passing the examination since it is not a mere screening test;

(iv) Whether any lower minimum qualifying marks (than the one prescribed by the first proviso to Regulation 9) can be prescribed at the post-graduate level of Medical education is a question which must be decided by the Medical council of India since it affects the standards of post-graduate Medical education. Prescribing the percentage of 20 per cent. for the reserved category and 45 per cent. for the general category is not permissible; the same being unreasonable at the post-graduate level and contrary to the public interest.

Connected Laws

Indian Medical Council Act, 1956

Indian Medical Council Rules, 1957
Post Graduate Committee Rules, 1961
Students Admitted In Excess Regulations, 1997
Graduate Medical Education Regulations, 1997
The MCI (Conduct Of Election) Regulations, 1998
Teachers Eligibility Qualifications, 1998
Establishment Of Medical College Regulations, 1999
Minimum Standard Requirement Regulations, 1999
Phasewise Requirements For LOI, LOP, Renewals
MCI Regulations, 2000
Opening Of A New Or Higher Course Of Study, 2000
P.G. Medical Education Regulations, 2000
Screening Test Regulations, 2002
Eligibility Certificate Regulations, 2002
Code Of Medical Ethics Regulations, 2002
Election Of Students Union Regulations, 2009
Prevention Of Ragging Regulation, 2009


Law regarding Medical Negligence in India.

Cases, both civil and criminal as well as in Consumer Fora, are often filed against Medical practitioners and hospitals, complaining of Medical negligence against doctors/hospitals/nursing homes and hence the latter naturally would like to know about their liability.

The general principles on this subject have been lucidly and elaborately explained in the three-Judge Bench decision of Supreme Court in Jacob Mathew vs. State of Punjab and Another (2005) 6 SCC 1. However, difficulties arise in the application of those general principles to specific cases.

 For instance, in para 41 of the aforesaid decision it was observed :

“The practitioner must bring to his task a reasonable degree of skill and knowledge, and must exercise a reasonable degree of care. Neither the very highest nor a very low degree of care and competence is what the law requires.”

Now what is reasonable and what is unreasonable is a matter on which even experts may disagree. Also, they may disagree on what is a high level of care and what is a low level of care.

To give another example, in paragraph 12 to 16 of Jacob Mathew’s case (supra), it has been stated that simple negligence may result only in civil liability, but gross negligence or recklessness may result in criminal liability as well. For civil liability only damages can be imposed by the Court but for criminal liability the Doctor can also be sent to jail (apart from damages which may be imposed on him in a civil suit or by the Consumer Fora). However, what is simple negligence and what is gross negligence may be a matter of dispute even among experts.

The law, like medicine, is an inexact science. One cannot predict with certainty an outcome of many cases. It depends on the particular facts and circumstances of the case, and also the personal notions of the Judge concerned who is hearing the case. However, the broad and general legal principles relating to Medical negligence need to be understood.

 Before dealing with these principles two things have to be kept in mind : (1) Judges are not experts in Medical science, rather they are laymen. This itself often makes it somewhat difficult for them to decide cases relating to Medical negligence. Moreover, Judges have usually to rely on testimonies of other doctors which may not necessarily in all cases be objective, since like in all professions and services, doctors too sometimes have a tendency to support their own colleagues who are charged with Medical negligence. The testimony may also be difficult to understand, particularly in complicated Medical matters, for a layman in Medical matters like a Judge; and (2) A balance has to be struck in such cases. While doctors who cause death or agony due to Medical negligence should certainly be penalized, it must also be remembered that like all professionals doctors too can make errors of judgment but if they are punished for this no doctor can practice his vocation with equanimity. Indiscriminate proceedings and decisions against doctors are counterproductive and serve society no good. They inhibit the free exercise of judgment by a professional in a particular situation.