ARAVINTH R.A. vs. THE SECRETARY TO THE GOVERNMENT MINISTRY OF HEALTH AND FAMILY WELFARE

REPORTABLE IN THE SUPREME COURT OF INDIA CIVIL APPELLATE JURISDICTION CIVIL APPEAL NO(S).3585­3586 OF 2022 (@ SLP(C)No(s). 5989­5990 of 2022) ARAVINTH R.A.                  …APPELLANT(S) VERSUS THE SECRETARY TO THE  GOVERNMENT OF INDIA MINISTRY OF HEALTH  AND FAMILY WELFARE & ORS.                              ...RESPONDENT(S) J U D G M E N T V. Ramasubramanian, J. 1.   Aggrieved   by   the   dismissal   of   his   two   writ   petitions   praying respectively for,   a declaration that Regulations 4(a)(i), 4(a)(ii), 4(b) & (i) 4(c) of the National Medical Commission (Foreign Medical Graduate Licentiate) Regulations 2021, hereinafter referred to as ‘ the Licentiate Regulations’ ; and   a declaration that Schedule­II 2(a) and 2(c)(i) of (ii) the   National   Medical   Commission   (Compulsory   Rotating   Medical Internship)   Regulations,   2021,   (hereinafter   referred   to   as   “CRMI Regulations” )   both   published   on   18.11.2021,   are   ultra   vires   and Signature Not Verified Digitally signed by SWETA BALODI Date: 2022.05.12 14:34:05 IST Reason: violative of Articles 14, 19(1)(g) and 21 of the Constitution, the writ 1 petitioner before the Madras High Court has come up with the above appeals. 2. We   have   heard   Mr.   Gopal   Sankaranarayanan,   learned   senior counsel appearing for the appellant. 3. The appellant completed his Higher Secondary education in the year 2021 under the C.B.S.E. Scheme. According to him, he appeared for NEET 2021 and obtained 55.443417 percentile score. His All India NEET Rank was 68772. Therefore, he could not get admission to a medical college of his choice in India. 4. Contending   that he wanted to join an Under Graduate Medical (i) Course   in   Anna   Medical   College,   Mauritius;   (ii)   that   due   to   the restrictions   on   international   travel   during   the   pandemic,   he   was unable to join the said Course during the academic year 2021­22; and (iii)   that in the meantime the National Medical Commission of India brought the Licentiate and CRMI Regulations, imposing heavy and arbitrary   burden   upon   students   who   want   to   pursue   medical education abroad, the appellant filed two writ petitions as aforesaid. 5. Finding that the impugned Regulations were issued with a view to ensure minimum standards and that they are in no way  ultra vires the Act or the Constitution, a Division Bench of the Madras High 2 Court dismissed the writ petitions. Holding that the appellant has not even made an application for admission to any institution in a foreign country and that therefore the writ petitions were nothing but a mis­ adventure, the High Court also imposed costs of Rs.25,000/­ upon the appellant. Therefore, the appellant has come up with these appeals. 6. As   indicated   at   the   beginning,   what   was   challenged   by   the appellant before the High Court were some provisions of two different st sets of Regulations. The 1  set of Regulations namely, the Licentiate Regulations   were   issued   by   the   National   Medical   Commission   in exercise of the powers conferred by Section 57 read with sub­section nd (4) of Section 15 of the National Medical Commission Act. The 2  set of   Regulations,   namely   the   CRMI   Regulations   were   issued   by   the Commission in exercise of the powers conferred by Section 57 read with sub­section (1) of Section 24 of the Act. 7. For   the   purpose   of  easy   reference,   the   Regulations  that were challenged   by   the   appellant   before   the   High   Court   of   Madras   are presented in two tabular columns as follows:­ NMC (FMGL) Regulations, 2021 (Licentiate Regulations)

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NMC (CRMI) Regulations, 2021

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8. The   challenge   of   the   appellant   to   some   provisions   of   the Licentiate Regulations, 2021 was on the following grounds:­ Regulations 4(a)(i), 4(a)(ii), 4(b) and 4(c) are violative of (i) the Right to Health, inherent in Article 21, as they tend to impair the right of the citizens to obtain quality medical treatment;   (ii) The impugned Regulations are issued in exercise of the powers conferred by Section 15(4) read with Section 57 of the Act, but these provisions do not confer any such power to  frame rules and regulations in respect of such matters; (iii) The   requirement   of   Regulation   4(a)(i)   that   the   foreign medical course should be of a duration of 54 months, will limit the choice available to students to select only those institutions which 5 offer a course  of a  duration  of 54 months. In  any case, Under Graduate Medical Course of a duration of less than 54 months is already recognised in Section 36(4) of the NMC Act. (iv) Regulation 4(a)(ii) which makes it mandatory for a foreign medical graduate to undergo an internship for a minimum duration of   12   months   in   the   same   foreign   medical   institution   and Regulation 4(b) which requires that such a graduate should have registered with the respective professional regulatory body of the country in which the degree was awarded, are clear examples of making extra­territorial legislation; (v) Regulation   4(c)   which   requires   the   foreign   medical graduates to undergo supervised internship in India for a minimum period of 12 months, causes undue hardship for the students, as they may have to undergo two internships, one in the foreign land and another in the mother land; (vi) Regulation 4(b) encroaches into the immigration policy of another country, in as much as it imposes an obligation upon the students   to   get   registered   with   the   professional   regulatory   body competent to grant licence to practice medicine in their respective jurisdiction; 6 The   impugned   Regulations   impose   unreasonable (vii) restrictions upon the right to practice medicine and they do not even serve public interest, as the country needs more doctors; (viii)   Unreasonable restrictions imposed by these Regulations will cause brain­drain from this country; The impugned Regulations tend to increase the average (ix) duration of the entire curriculum up to the stage of registration as a medical practitioner, to 8­9 years for a foreign medical graduate, though it is just 5½ years for an Indian medical graduate. Since the system of Modern Medicine or Allopathy is the same throughout the world   and   since   it   cannot   differ   from   country   to   country,   the classification   of   students   into   two   categories   namely   those   who study in India and those who study abroad, is violative of Article 14. 9. The challenge of the appellant to the second set of Regulations namely the CRMI Regulations, 2021, is on the following grounds:­ (i) Schedule   II­Para   2(a)(i)   requires   all   foreign   medical graduates   to   undergo   internship   at   par   with   Indian   medical graduates.   But   the   Regulations   do   not   treat   foreign   medical graduates at par with Indian medical graduates. Therefore, there is dichotomy. There are several countries such as Ukraine, Georgia, 7 Nepal, Bangladesh, Armenia, Philippines and Malaysia, which offer primary   medical   qualification   without   mandatory   internship. Medical institutions in countries like Mauritius offer to their foreign students, the option to do compulsory rotating medical internship in the country of their origin. But Schedule­II of the Regulations deprives the students of these opportunities; (ii) Schedule­II Para 2(c)(i) allows foreign medical graduates to be posted first in colleges which have been newly opened and have   yet   to   be   recognised.   This   will   dissuade   students   from pursuing   medical   education   abroad,   as   their   future   will   be   a question mark. 10. But   we   do   not   think   that   any   of   the   above   grounds   of challenge are sustainable in law. The Regulations impugned by the appellant may appear superficially to be rigorous or tough. But these  Regulations   are   a   product   of,   (i)   past  experience;   and   (ii) necessity of times. Experts in the field of education believe (and justifiably   so)   that   over   ambitious   parents,   hapless   children, exploitative and unscrupulous (and sometimes unlettered) founders of   infrastructure­deficient   educational   institutions,   paralysed regulatory bodies and courts with misplaced sympathy, have all 8 contributed   (not   necessarily   in   the   same   order)   to   the commercialisation of education and the decline of standards in the field of education, in general and medical education, in particular. We may be able to appreciate this, if we have a look at the history of evolution of statutory measures taken to regulate the recognition and registration of foreign medical degrees in India. 11. The problem of unrecognised institutions offering diplomas/ degrees in medicine and untrained individuals practising medicine, is not new, but is a century old phenomenon in India. This can be seen from the fact that the first attempt to regulate the grant of titles implying qualifications in western medical science was made under the Indian Medical Degrees Act, 1916, which is an Imperial Act. Though   there  were   Acts   of   the   Local  Council  in   the   larger provinces of British India such as Bombay, Bengal and Madras provinces, they were found to be toothless. Therefore, the Statement of Objects and Reasons of the Indian Medical Degrees Act, 1916 recorded:­ “… It has been found that at present, diplomas are issued   by   private   institutions   to   untrained   or insufficiently   trained   persons,   and   that   many   of these diplomas are colourable imitations of those issued   by   recognised   Universities   and Corporations.  The result is that recipients of such 9 diplomas   are   able   to   pose   to   the   public   as possessing qualifications in medicine and surgery which they do not possess …” 12. Subsequently, an Act to constitute a Medical Council in India was enacted under the title   Indian Medical Council Act, 1933.  The object of creation of a Medical Council in India, as stated in the preamble of this Act, was to establish a uniform minimum standard higher   qualification   in   Medicine   for   all   the   provinces.   This   Act divided   the   medical   qualifications   into   three   categories   namely,   those granted by medical institutions in the States included in (i) the First Schedule;  (ii)  those granted by medical institutions in the States not included in the First Schedule; and   those granted by (iii) medical institutions outside those States. 13. The   First   Schedule   to   the   1933   Act   included   Indian Universities   and   the   Second   Schedule   included   institutions   in countries like United Kingdom, Australia, Burma, Canada etc. It may be of interest to note that Osmania University of Hyderabad was included in the Second Schedule, as Hyderabad was not, at that point of time, a part of British India. Section 12 of the 1933 Act granted   automatic   recognition   to   the   medical   qualifications 10 obtained   from   the   universities   of   the   countries   included   in   the Second Schedule. 14. After India attained independence, the Indian Medical Council Act, 1956 was passed and it came into force on 01.11.1958. This Act repealed the Indian Medical Council Act, 1933. This Act was intended to provide for the reconstitution of the Medical Council of India and the maintenance of a Medical Register for India and such other matters connected therewith. 15. The Statement of Objects and Reasons shows that the Act was intended,  (i)  to provide for the registration of the names of citizens of India who have obtained foreign medical qualifications, which were   not   recognised   at   that   time;   and     to   provide   for   the (ii) temporary recognition of medical qualifications granted by medical institutions in the countries outside India with which no scheme of reciprocity existed. 16. Section   11   of   the   1956   Act   contained   provisions   for   the recognition   of   medical   qualifications   granted   by   universities   or medical   institutions   in   India.   The   First   Schedule   to   the   Act contained the list of universities and medical institutions in India, the medical qualifications granted by which, were required to be 11 recognised by Section 11(1). Section 11(2) dealt with universities and medical institutions in India not included in the First Schedule. 17. Section 12 contained provisions for the recognition of medical qualifications   granted   by   medical   institutions   in   countries   with which there was a scheme of reciprocity. Such medical institutions were included in the Second Schedule.   18. Section 13 provided for recognition of medical qualifications granted by medical institutions, which are not included in the First Schedule or Second Schedule but included in the Third Schedule. The Third Schedule itself comprised of two parts. It is Part­II of the Third   Schedule   which   contained   a   list   of   recognised   medical qualifications   granted   by   medical   institutions   outside   India,   not included in the Second Schedule. 19. Sub­section (3) of Section 13 of the Indian Medical Council Act,   1956   provided   for   the   recognition   of   medical   qualifications granted by medical institutions outside India, which are included in Part­II  of   the   Third   Schedule,   subject   to   the   condition   that  the enrolment   of   a   person   possessing   such   qualifications,   in   the Medical Register, would be conditional upon his being a citizen of India and his having undergone such practical training as may be 12 required by the Rules and Regulations in the country granting the qualification. If he has not undergone any practical training in that country, he must undergo practical training as may be prescribed under the Act. 20. The 1956 Act, as it was originally enacted, enabled the Central Government   under   Section   13(4),   to   amend   Part­II   of   the   Third Schedule, after consulting the Medical Council of India, so as to include therein any qualification granted by a medical institution outside India which is not included in the Second Schedule.  21.  But  the real headache  for the  1956  Act started, when the Government of India requested the MCI in the year 1981 to consider the grant of recognition for medical courses in medical institutions in the erstwhile U.S.S.R. The Medical Council examined the request and   submitted   a   report,   after   which   certain   institutions   in   the erstwhile   U.S.S.R.   were   recognised   and   included   in   the   Second Schedule of the Act. 22. After the disintegration of U.S.S.R., institutions with dubious reputations   mushroomed   (perhaps   showing   the   way   forward   for many back home), forcing MCI to recommend in the year 1994, the de­recognition of all the medical degrees of the erstwhile U.S.S.R. 13 Though   the   students   were   sufficiently   warned   by   MCI   through advertisement issued in August, 1997 and the Executive Committee took certain decisions, those decisions were diluted by a high level committee in a meeting held in November, 1998. Eventually, it was decided to undertake a process of post­screening, for those coming back to India and a system of pre­screening was recommended for those desirous of taking admission in medical institutions of those countries. 23. Challenging   those   decisions,   writ   petitions   were   filed   in different High Courts by persons who had undergone courses in Medicine in medical colleges in the erstwhile U.S.S.R. The Delhi High Court took the lead and was the first to grant relief to the candidates.   When   the   matter   reached   this   Court,   certain suggestions   were   made   and   the   General   Body   of   MCI   met   on 31.03.2000 and passed certain Resolutions. 24. In   order   to   give   effect   to   the   Executive   decisions,   the Government   of   India   introduced   a   bill   in   March   2001   for   the amendment of the 1956 Act. After the bill was passed, Section 13 of the Act  got  amended.  By  this  Amendment  Act  34  of  2001,  two provisos  and an  Explanation  were inserted under sub­section (4) of 14 Section 13. In addition, sub­sections (4A), (4B) & (4C) were also inserted under Section 13(4). 25. Sub­section (4A), (4B) and (4C) of Section 13 inserted by Act 34   of 2001 read as follows:­ (4A) A person who is a citizen of India and obtains medical qualification granted by any medical institution in any country outside India recognized for enrolment as medical practitioner in that country after such date as may be specified by the Central Government under sub­section (3),shall not be entitled to be enrolled on any  Medical Register  maintained by   a State Medical Council   or   to   have   his   name   entered   in   the   Indian Medical Register unless he qualifies the screening test in India prescribed for such purpose and such foreign medical   qualification   after   such   person   qualifies   the said   screening   test   shall   be   deemed   to   be   the recognised   medical   qualification   for   the   purposes   of this Act for that person.  (4B) A person who is a citizen of India shall not, after such   date   as   may   be   specified   by   the   Central Government  under   sub­section (3),  be  eligible  to get admission to obtain medical qualification granted by any medical institution in any foreign country without obtaining an eligibility certificate issued to him by the Council   and   in   case   any   such   person   obtains   such qualification   without   obtaining   such   eligibility certificate,   he   shall   not   be   eligible   to   appear   in   the screening test referred to in sub­section (4A):  Provided that an Indian citizen who has acquired the medical qualification from foreign medical institution or has obtained admission in foreign medical institution before   the   commencement   of   the   Indian   Medical Council (Amendment) Act, 2001 shall not be required to obtain eligibility certificate under this sub­section but, if he is qualified for admission to any medical course for   recognized   medical   qualification   in   any   medical institution in India, he shall be required to qualify only the   screening   test   prescribed   for   enrolment   on   any 15 State Medical Register or for entering his name in the Indian Medical Register.  (4C) Nothing contained in sub­sections (4A) and (4B) shall apply to the medical qualifications referred to in section 14 for the purposes of that section. 26. As seen from the aforesaid provisions, sub­sections (4A)& (4B) of Section 13 operated in two different time zones, namely pre­ admission to the course and post­completion of the course. While Sub­section (4B) spoke about an  eligibility certificate  to be obtained by a candidate before seeking admission to any medical institution in any foreign country, sub­section (4A) spoke about a   screening test  in India, the passing of which was necessary, to get enrolled on any Medical Register. 27. After the insertion of sub­sections (4A) and (4B), two sets of Regulations were put in place. One was the “Eligibility Requirement for   taking   admission   in   an   undergraduate   medical   course   in   a Foreign Medical Institution Regulations, 2002”, and another was “Screening Test Regulations, 2002”. 28. Regulations 3 and 4 of the Screening Test Regulations, 2002 read as follows:­ “3. An Indian citizen or a person who has been granted Overseas   Citizenship   of   India   possessing   a   primary medical   qualification   awarded   by   any   medical institution   outside   India   who   is   desirous   of   getting provisional or permanent registration with the Medical 16 Council of India or any State Medical Council on or after 15.03.2002 shall have to qualify a screening test conducted by the prescribed authority for that purpose as per the provisions of section 13 of theAct:  Provided that a person seeking permanent registration shall not have to qualify the screening test if he/ she had already qualified the same before getting his/ her provisional registration. 4. Eligibility Criteria: No person shall be allowed to appear in the screening test unless:  (1)No persons shall be allowed to appear in screening test unless:he/she is a Citizen of India or has been granted Overseas Citizenship of India and possess any primary medical qualification, which is confirmed by the   Indian   Embassy   concerned,   to   be   a   recognized qualification for enrolment as medical practitioner in the country in which the institution awarding the said qualification is situated (2) he/ she had obtained ‘Eligibility Certificate’ from the   Medical   Council   of   India   as   per   the   ‘Eligibility Requirement   for   taking   admission   in   an undergraduate  medical  course   in  a  Foreign   Medical Institution Regulations, 2002’. This requirement shall not   be   necessary   in   respect   of   Indian   citizens   or Overseas   Citizens   of   India   who   have   acquired   the medical qualifications from foreign medical institutions or   have   obtained   admission   in   foreign   medical th institution before 15 March, 2002. (3) He/She has studied for the medical course at the same institute located abroad for the entire duration of the   course   from   where   he/she   has   obtained   the degree. Provided   in   cases   where   Central   Government   is informed of condition of war, civil unrest, rebellion, internal   war   or   any   such   situation   wherein   life   of Indian citizen is in distress and such information has been   received   through   the   IndianEmbassy   in   that country then the Council shall relax the requirement of   obtaining   medical   education:   from   the   same institute   located   abroad   in   respect   of   which communication   has   been   received   from   the   Indian Embassy in that country. 17 (4) Provided further that a person seeking provisional or permanent   registration   shall   not   have   to   qualify   the Screening   Test   if   he/she   holds   an   Undergraduate medical   qualification   from   Australia/Canada/New Zealand/United Kingdom/United States of America and the holder thereof also been awarded a Post Graduate medical   qualification   in Australia/Canada/NewZealand/United   Kingdom/United States of America and has been recognized for enrolment as medical practitioner in that country.” 29. Both the above sets of Regulations were notified by the MCI on 18.02.2002. The date from which the provisions of the Regulations would take effect was prescribed as 15.03.2002. As a result, the appeals arising out the decisions of the Delhi High Court and the Allahabad High Court were disposed of by this Court by an order reported in   Medical Council of India   vs.   Indian Doctors from 1 . Russia Welfare Associations &Ors. 30. However, another round of litigation started, with the filing of a batch of writ petitions on the file of this Court under Article 32 of the Constitution, at the instance of students who joined the Course in 1994 or 1995 or 1996 or 1999 or 2000. The challenge of these petitioners was to the Screening Test Regulations, 2002. But by a 2 judgment   in   Sanjeev   Gupta   vs.   Union   of   India ,   this   Court rejected the challenge. 1 (2002) 3 SCC 696 2 (2005) 1 SCC 45 18 31. In April 2010, the MCI was rocked by a shameful scam of epic proportions, which led to the promulgation of the Indian Medical Council (Amendment) Ordinance, 2010 on 15.05.2010 superseding the Indian Medical Council and appointing a Board of Governors. The Ordinance was soon replaced by the 2010 Amendment Act. Subsequently, extension of the supersession from time to time was made under the Indian Medical Council (Amendment) Act, 2011, the Indian  Medical  Council (Amendment)  Act,  2012   and  by two subsequent ordinances. 32. At about the same time when the MCI was embroiled in a controversy,   an   amendment   was   made   to   Regulation   4   of   the Screening Test Regulations, 2002 with effect from 16.04.2010. The Amendment   was   to   the   effect   that   a   foreign   medical   graduate should have completed his entire medical course from the same institution located abroad, in order to be eligible to appear for the Screening   Test.   On   account   of   this   Amendment,   students   who pursued Under Graduate medical education partly in one foreign country and partly in another foreign country were disqualified to take the Screening Test. 19 33. Therefore, some of the students affected by the amendment to the Screening Test Regulations filed a batch of writ petitions on the file   of   the   Delhi   High   Court   assailing   Regulation   4(3)   of   the Screening   Test   Regulations   2002,   as   amended   with   effect   from 16.04.2010, as   ultra vires   the provisions of the Act. The Division Bench of the Delhi High Court, by a judgement dated 27.09.2013 3 passed in   Rohit Naresh Agarwal   vs .   Union of India   declared Regulation 4(3) as amended by the 2010 Regulations to be   ultra vires  the Act, in view of the purported legislative policy reflected in sub­sections (4A) and (4B) of Section 13 and the extent of power available in Clause (ma) of Section 33.  34.   The   Medical   Council   of   India   filed   Special   Leave   Petitions against the said judgement of the Delhi High Court. After granting leave,   those   petitions   were   dismissed   on   the   ground   that   the decision   of   the   High   Court   in   declaring   Regulation   4(3)   of   the Screening Test Regulations 2002 as ultra vires, did not suffer from any error.  35. Immediately after the 2010 Amendment to the Screening Test Regulations, but before the decision of the Delhi High Court in 3 (2013) 204 DLT 401 (DB) 20 , this court had an occasion to deal Rohit Naresh Agarwal  (supra) with the case of students who completed the first two terms of an undergraduate medical course in an unrecognised medical college in India, but completed the last term in a medical institution in Tanzania. The batch of students comprised of (1) some, who were declined provisional registration and who could not do internship in India,   (2)   some,   who   were   granted   provisional   registration, completed internship, but declined permanent registration and (3) some, whose permanent registration was subsequently cancelled. The High Court granted relief to all of them and the judgement of the   High   Court   was   under   challenge   before   this   Court.   By   a judgement   reported   in   vs. Medical   Council   of   India     J.   Saai 4 Prasanna   &   Ors. ,   this   court   affirmed   the   judgement   of   the Andhra Pradesh High Court. While doing so, this court held that “ so long as the medical institution in a country outside India has granted   a   medical   qualification   and   that   medical   qualification   is recognized for enrolment as medical practitioner in that country, all that is required for the purpose of enrolment in the medical Register in India is qualifying in the Screening Test in India ”.  4 (2011) 11 SCC 748. 21 36. More importantly, this Court held in paragraph 12 as follows:  “ 12. In the case of persons who obtained a medical qualification in a medical institution outside India, the question   as   to   where   the   course   of   study   was undergone is not relevant. The course of study could be in that country or if the norms of the Medical Council of that country so permitted, the course of study could be partly in that  country and  partly in another country including India.Once that country recognises a medical qualification granted by the institution in that country for the purpose of enrolment as a medical practitioner in that country, and such medical degree­holder passes the screening test in India, the Medical Council of India cannot refuse to recognise such degree on the ground that the student did a part of his study in an institution in India as a part of his medical study programme for the foreign institution.”  37. Thus, every time when the Regulatory body attempted to plug the loopholes and reform the system, which was exploited by a few, there was a challenge to the same and the irresistible temptation to undertake an irresponsible research in the nuances of law, set them at   naught   many   times.   Courts,   sometimes,   were   swayed   by sympathy to the plight of a few students, little realising that the plight of the patients who would go to them will hardly come to light and the impact such decisions would have on the population would never be known. 38. Be   that   as   it   may,   the   above   developments   shocked   the conscience of a few (at least a few), which led, in the year 2014, to 22 the constitution of a Group of Experts chaired by Dr. Ranjit Roy Chaudhury   to   study   the   Indian   Medical  Council   Act,   1956  and make recommendations to the Government to make the Medical Council   of   India   (MCI),   modern   and   suited   to   the   prevailing conditions.  39.   The   report   of   the   said   Group   of   Experts   was   subsequently examined by the Parliamentary Standing Committee on Health & Family Welfare and they submitted a report known as 92nd Report. Further, a four­member committee headed by the Vice Chairman, NITI Aayog was constituted to examine all options for reforms in MCI and to suggest a way forward. The Committee framed a draft “National Medical Commission (NMC) Bill”.  40. In  Modern Dental College and Research Centre & Ors.  vs. 5 this Court directed the Central State of Madhya Pradesh &Ors. ,  Government to take action on the above recommendations.  It was in   the   light   of   such   developments   that   the   National   Medical Commission Act, 2019 ( hereinafter referred to as ‘NMC Act ’) was passed. 5 (2016) 7 SCC353 23 41. The   NMC   Act   provided   for   the   constitution   of   a   National Medical   Commission   and   the   constitution   of   four   autonomous boards, each with a different mandate. The Act provided for the recognition  of   medical qualifications   granted   by   universities  and institutions in India under Section 35 and recognition of medical qualifications granted by medical institutions outside India, under Section 36.  Section 36 of the Act reads as follows:­ 36. Recognition of medical qualifications granted by medical institutions outside India.­ (1)  Where an authority in any country outside India, which by the law of that country is entrusted with the recognition of medical qualifications in that country, makes an application to the Commission for granting recognition to such medical qualification in India, the Commission   may,   subject   to   such   verification   as   it may deem necessary, either grant or refuse to grant recognition to that medical qualification: Provided   that   the   Commission   shall   give   a reasonable   opportunity   of   being   heard   to   such authority before refusing to grant such recognition. (2)   A   medical   qualification   which   is   granted recognition by the Commission under sub­section (1) shall   be   a   recognised   medical   qualification   for   the purposes of this Act, and such qualification shall be listed   and   maintained   by   the   Commission   in   such manner as may be specified by the regulations. (3)   Where   the   Commission   refuses   to   grant recognition   to   the   medical   qualification   under   sub­ section   (1),   the   authority   concerned   may   prefer   an appeal   to   the   Central   Government   against   such decision within thirty days of communication thereof. (4) All medical qualifications which have been recognised before the date of commencement of this Act and are included in the Second Schedule and Part 24

42. Similarly, the Act also provided for withdrawal of recognition granted to a medical qualification, granted by medical institutions in   India   under   Section   38   and   the   de­recognition   of   medical qualifications granted by medical institutions outside India. There was   also   a   special   provision   in   Section   40   for   the   grant   of recognition   to   any   medical   qualification   granted   by   a   medical institution   in   a   country   outside   India,   provided   that   medical practice by a person possessing such qualification would depend upon his qualifying in the National Exit Test. 43. While Section 56 of the Act confers powers upon the Central Government   to   make   rules,   Section   57   confers   power   upon  the National   Medical   Commission   to   make   regulations.   In   order   to ensure that the power of the Commission to frame regulations is very wide, sub­section (2) of Section 57 lists out about 46 matters, in respect of which NMC may make regulations. 44. It is in exercise of the power conferred by Section 57 read with sub­section (4) of Section 15 that the Licentiate Regulations 2021 25 were issued. Section 15 provided for the conduct of the National Exit Test. Sub­section (4) of Section 15 mandated that any person with a foreign medical qualification shall have to qualify National Exit Test for the purpose of obtaining licence to practice Medicine. Section 15(4) reads as follows:­

     xxx                               xxx                               xxx” 45. Clause (k) of sub­section (2) of Section 57 indicates that the Regulations framed by NMC may deal with “ the manner in which a person with foreign medical qualification shall qualify National Exit Test under sub­section (4) of Section 15 ”. 46. At this stage we may take a small detour to point out that the Kerala   State   Medical   Council,   without   waiting   for   the   Central Government   to   clean   up   the   MCI,   took   the   lead   and   passed   a Resolution dated 20.10.2017, making it compulsory for all foreign medical   graduates   to   complete   one   year   internship   in   any institution   within   India   approved   by   MCI,   for   the   grant   of 26 permanent registration in the State of Kerala under the Travancore­ Cochin Medical Practitioners Act, 1953. On the basis of the said Resolution,   the   application   for   permanent   registration   of   some foreign medical graduates were rejected and the rejection became the subject matter of challenge in  Dr. Amala Girijan and Ors.   vs. 6 The Registrar, Travancore­Cochin Medical Council and Ors. The challenge was on the ground that the Resolution of the State Medical Council was in violation of Section 37 of the State Act. However,   the   challenge   was   rejected   by   a  learned   Judge   of   the Kerala High Court. 47. But subsequently, the same Resolution came to be challenged by another foreign medical graduate in   Sadhiya Siyad  vs.   State 7 of Kerala and Ors.     Another learned Judge of the Kerala High Court before whom the writ petitions came up, framed the following four questions as arising for consideration:­

6  2019 (4) SCT 224 (Kerala) 7  2021 (6) KLT 94 27

48. The Kerala High Court held,   (i)   that the stand of the State Medical Council that only students who have completed internship as part of the medical course undertaken by them in the medical institutions abroad, are entitled to appear for the Screening Test, is unsustainable;   (ii)  that if a candidate satisfied all the requirements for enrolling as a medical practitioner on a State Medical Register in accordance with the provisions of the 1956 Act and the Regulations made there   under,   he   cannot  be   denied   registration   by   a  State Medical   Council;   (iii)   that   if   a   candidate   satisfied   all   the requirements   for   enrolling   as   a   medical   practitioner   on   a   State Medical Register in accordance with the provisions of the 1956 Act and the regulations made there under, the State Medical Council cannot   deny   enrolment   on   the   ground   that   the   candidate   had obtained Eligibility Certificate after taking admission to the medical 28 institution abroad and was consequently not eligible to appear for Screening Test;    the requirement stipulated by the Kerala State (iv)  Medical   Council   that   such   foreign   medical   graduates   should undergo CRRI for claiming permanent registration, is inconsistent with the requirements of the 1956 Act and the Regulations; and  (v) that since the 1956 Act is relatable to Entry 66 of List­I of the Seventh   Schedule   of   the   Constitution,   it   would   prevail   over  the Kerala enactment relatable to Entry 25/26 of List­III. 49. Though the High Court of Kerala allowed the writ petition filed by  , it was made clear in the said Judgment that the Sadhiya Siyad same would not preclude the State Medical Council from bringing to the   notice   of   the   NMC,   the   requirement   if   any,   for   the   foreign medical graduates to undergo internship afresh to get acclimatised with the diseases and requirements of treatment peculiar to the State   in   order   to   bring   in   force,   the   appropriate   statutory amendments. 50. Thus,   a   stage   was   set   for   the   NMC   to   issue   appropriate regulations in exercise of the power conferred by Section 57 of the Act.  Accordingly, the Licentiate Regulations were issued in exercise of the power conferred by Section 15(4) read with Section 57 and 29 the   CRMI   Regulations   were   issued   in   exercise   of   the   power conferred by Section 24(1) read with Section 57 of the Act.  Keeping these developments in mind, let us now test the validity of the grounds of challenge to these Regulations. 51. As we have seen earlier, the appellant challenged the validity of Regulation 4(a)(i) and Regulation 4(a)(ii), 4(b) and (4(c) of the Licentiate Regulations on several grounds, one of which is the lack of power under the Act. But the provisions extracted above would show that NMC had the power to frame the above Regulations. 52. Prescription of  minimum standards would certainly include the prescription of the minimum duration for a course. It may be open to the medical institutions of other countries to prescribe a duration of less than 54 months for the students of their country. But it is not necessary for the NMC and the Central Government to recognise   foreign   medical   degrees   of   a   lesser   duration,   if   the incumbent wants to have permanent registration in India.   53. The prescription of an internship for a minimum duration of 12 months in the same foreign medical institution cannot also be said to be a duplication of internships. The purpose of internship is to test the ability of the students to apply their academic knowledge 30 on their subjects, namely the patients.  Medical institutions of other countries may not insist on rigorous internship for students who may not put to test their skills on the population of their country. But it is not necessary for us to follow suit. 54. Similarly,   the   requirement   under   Regulation   4(b)   has   been necessitated   to   ensure   that   the   students   who   were   imparted medical education in a foreign country demonstrate their skills first on the population of the country where they studied. The necessity for a Master Chef to taste the food prepared by him, before it is served on the guests, cannot be said to be arbitrary.  Therefore, the challenge to the Licentiate Regulations, are wholly without basis. 55. The contention that Section 36(4) recognises M.B.B.S. courses of   a   duration   of   less   than   54   months   and   that   therefore   the Licentiate Regulations being a subordinate legislation is  ultra vires , is wholly unsustainable. All that sub­section (4) of Section 36 saves, are   the   qualifications   already   recognised   before   the   date   of commencement of the Act and included in the Second Schedule and Part­II of the Third Schedule to the 1956 Act. The fact that past sins are sought to be washed away, is no ground to hold that there cannot be a course correction. As a matter of fact, Section 60 which 31 deals with repeal and saving, also saves under clause (b) of sub­ section (2), any right, privilege or obligation already acquired.  This cannot be stated to be in conflict with what is prescribed for the students of the future. In any case, Section 36 deals only with recognition of the foreign medical courses and not registration as medical   practitioner.   Registration   is   covered   by   Section   33. Therefore, Section 36(4) cannot help the appellant. 56. The contention that the country needs more doctors and that by   restricting   the   registration   of   foreign   medical   graduates,   the fundamental right of the professionals under Article 19(1)(g) and the fundamental right of the citizens under Article 21 are impaired, is to be stated only to be rejected. It is true that the country needs more doctors, but it needs really qualified doctors and not persons trained   by   institutions   abroad,   to   test   their   skills   only   in   their mother land. 57. The   argument   that   these   Regulations   constitute   an   extra­ territorial law is misconceived. These Regulations do not encroach into the sovereignty of the countries where those institutions are located, by stipulating minimum standards for the students who want   to   practise   there.   These   Regulations   merely   prescribe   the 32 minimum standards to be fulfilled by those who study in those institutions but who want to practise here in India. 58. Insofar   as   the   challenge   to   the   CRMI   Regulations   are concerned,   the   same   is   without   any   substance.   If   there   are institutions   in   some   countries   which   offer   primary   medical qualification   without   mandatory   internship,   the   students   are supposed not to seek admissions in those institutions. The mad rush to become qualified medical professionals, cannot drive them to   countries   where   short­cuts   to   success   are   offered.   The requirement under Para 2(a) of Schedule­II of these Regulations for foreign medical graduates to undergo internships at par with Indian medical graduates is to ensure that only those who have acquired similar skills are allowed to practice Medicine. 59. The   prescription   in   para   2(c)(i)   of   Schedule­II   of   these Regulations that such foreign medical graduates may be posted first in   colleges   which   have   been   newly   opened   and   have   yet   to   be recognised, is a prescription of necessity. All medical institutions of the country are equipped to provide internships only to as many students   as   their   permitted   intake   may   allow.   Therefore,   this 33 Regulation is intended to ensure that an undue burden is not cast upon the already recognised institutions. 60. Therefore, we find that the dismissal of the writ petitions filed by the appellant before the Madras High Court was fully justified. We could have dismissed the SLPs  in limine , but we thought fit to take   pains   to   bring   on   record   the   historical   facts   so   that   the challenge to these Regulations are nipped in the bud and they do not surface in a different form or  avatar . 61. In view of the above, the appeals are dismissed. However, the costs imposed by the High Court of Madras upon the appellant is waived off, taking into account of the fact that he is a student and also for the purpose of showing the only extent to which, a court can show sympathy in such matters. ………………………………….J. (Hemant Gupta) ………………………………….J. (V. Ramasubramanian) New Delhi May 2, 2022 34