The National Medical Commission Bill has in recent times been the centre of protest in the medical fraternity. It has been criticised for legalizing quackery and diluting the rigour in the practice of allopathic medicine in India. This bill is an outcome of long-standing efforts to reconstitute the Indian Medical Council. However, in the process of drafting the bill, some of the crucial provisions have been diluted and the rigour of regulating the medical profession has reduced. Ambiguity and lack of rigour in crucial areas such as these have social repercussions and require effective legal change. Apart from these areas, it has also reduced the role of trained professionals in regulating medical education and practise and provides greater scope for government involvement in this body.
Dissolution of the Indian Medical Council
Medical education and medical practise in India was regulated by the Medical Council of India (MCI). This body was established in the year 1934 under the Indian Medical Council Act of 1933. It was later reconstituted under the new Indian Medical Council Act of 1956. This act changed the structure and composition of the MCI. There are 4 major functions associated with the Medical Council of India and these cover the areas of medical education and medical practise in India. They include, establishing and maintaining the standards for medical education in India; accreditation and regulation of medical colleges in India that provide undergraduate and post-graduate medical education in India; recognition of medical qualifications provided by the University Grants Commission and foreign institutions; and lastly, maintenance of the national medical registry and registration of qualified medical professionals.
The MCI was dissolved in 2010 by the then President following corruption charges against the top administrators. It was found that a bribe was taken to grant permission for the expansion of the number of medical seats in a medical college in Punjab. Following the arrest of the top officials by the CBI, this body was dissolved. The functioning of the Council was diminished thereafter and efforts to rebuild it have been undertaken in an ad-hoc manner. In 2018, a six doctor committee was formed to lead the MCI. Later, the National Medical Commission Bill was formulated and recently passed in the Rajya Sabha. This Act provides for the formation of National Medical Commission which will come to replace the Medical Council of India.
Controversial provisions of NMC bill
The medical fraternity in India has been in opposition towards various provisions of this NMC Bill that was recently passed in the Rajya Sabha. Their objections are based on three major provisions that are considered to be controversial. Their concern falls in areas that might have a huge impact on the quality and qualifications of medical professionals throughout India. They find these provisions to be a huge threat for the public health system in India and demand for greater restrictions and qualification requirements for health care professionals. This creates a need to listen to the demands of the medical fraternity.
The first problematic area is section 32 of the NMC Act. This section basically provides for licenses to over 3.5 lakh community health providers and non-medical professionals to practise medicine. This bill states that a limited license will be provided for community health providers restricted to areas of mid-level of the public health care system. The areas of medical operations that they can take part in are actually defined under this section. The community health care worker would be working independently in the areas of primary and preventive care. In other areas, they are allowed to prescribe medicines under the supervision of a medical practitioner.
The second problematic provision is with regard to the removal of the NEET-PG examination for postgraduate medical education. The section 15 (1) of the NMC Bill states that a National Exit Test (NEXT) would be conducted in the final year of undergraduate education and this score will be used for enrolment in the national medical register and for applications into postgraduate programmes. In a joint statement of various medical practitioners associations, this provision has been considered a breach of ethics and as disregard for the noble profession. They also feel that this bill is a “mockery of professionals” and “nothing short of draconian”.
The third problem area is with regard to the constitution of the National Medical Council. The Act stipulated that there shall be 25 members who would constitute this body. Of these, only 5 members are to be elected and the other 20 members shall be appointed or nominated by the government. These members can be government officials and non-medical professionals. The view of the medical fraternity is that MBBS graduates need to be governed by other qualified MBBS graduates. They believe that their representation should be based on election and not nomination. This provision also seems to compromise on the autonomy of the body. Their demand is that the government should only advise the NMC and not direct the body.
The NMC bill and quackery
The provisions of the NMC Bill seem to be in a way legalising quackery in the medical profession. Section 32 of the bill is very ambiguous and gives room for quackery to take place legally. This has a huge social implication of an ambiguous provision in a very crucial area of public health. In a large country like India with a huge rural uninformed population, this provision could be actually disastrous. Though there are limitations in the license given to community health providers, the enforcement of these limits can actually be very difficult and problematic.
The rationale for the implementation of such a provision is that we need sufficient medical professionals to cater to the health needs of a large population. This would essentially mean that there are also insufficiently trained professionals to actually monitor that there are no misuses of this section. Individuals with no medical background can actually prescribe medicines and wrongfully diagnose individuals without any monitoring by a trained professional. In a way, quackery now has a legal provision that would allow for untrained individuals with no medical education to actually do parts of the functions of trained doctors and medical professionals.
This has been heavily critiqued by the medical fraternity for two major reasons. The first reason being the social consequences that quackery would create. Law cannot be conducive for the development of social harm that would threaten the lives of people. In a way, this can also be seen as a violation of people’s right to life itself. The second reason for their protests is due to the disrespect of the qualifications and hours of practice put in by trained professionals. They view this as an act to dilute the rigour of the medical profession along with reducing their autonomy in regulating health care.
Need for ambiguity resolution
The most probable step ahead would be to provide an enforceable definition for ‘community health provider’. Initially, the act provided for the training of these providers before allowing them to engage in these activities. However, the bill removed such a provision. Reconstituting these provisions along with more clarity and setting proper limits to their practice becomes very important for preventing any unintended negative effects. Though we have a need for a large number of medical professionals to provide universal healthcare, we cannot do so by promoting quackery. The medical fraternity is of the view that qualitative improvement should be given focus on quantitative expansion. At this juncture, we can only hope that the demands of the medical professionals will be taken into consideration. With continued inaction, the future remains bleak.
Picture Courtesy- Zee News