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Indian Medical Council (Amendment) Bill 2019: Continuation of ad hoc approach to regulatory functions

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Indian Medical Council (Amendment) Bill 2019: Continuation of ad hoc approach to regulatory functions

It reflects poorly on the central government for failing to fix the regulatory body governing medical education and practices in India for the past 10 years.

The India Medical Council (Amendment) Bill of 2019, passed by the Parliament this week, allows the central government to take over the Medical Council of India (MCI) - an elected body of medical doctors which regulates medical education and practices in India - for a period of two years. It replaces the second ordinance promulgated for this purpose in January this year.

This is continuation of an ad hoc process to clean up the regulatory body that began in 2010. Twice did the government try to replace the MCI with a new regulatory body - first with the National Council of Human Resources in Health (NCHRH) in 2011 and then with the National Medical Commission (NMC) in 2017 - but both attempts did not materialise.

The Union Health Minister Harsh Vardhan justified the takeover by saying that the MCI had failed to discharge its duties and indulged in corrupt practices. The MCI was taken over first in 2010, following the arrest of its president Ketan Desai by the Central Bureau of Investigation (CBI) for allegedly accepting a bribe of Rs 2 crore to grant recognition to a medical college in Punjab.

A Parliamentary panel which examined the MCI's functioning in 2016 had listed several complaints against the regulator: lack of accountability and transparency, failure to discharge its mandated responsibilities, rampant corruption, poor regulation of undergraduate and postgraduate education, etc.

What the Bill says

The Bill supersedes the MCI for a period of two years and vests its powers in a government-appointed Board of Governors (BoG), which would now have 12 members - instead of seven earlier. It also allows a new category of people with "proven administrative capacity and experience" to the GoB, apart from medical doctors.
Further, the BoG would be assisted by a Secretary General (SG) to be appointed by the central government and head the secretariat in the Council.

Long struggle to fix MCI

The current cycle of fixing the MCI began in 2009 with a Presidential declaration to establish an overarching regulatory body for the entire health sector - the NCHRH - as a move to reform the regulatory frameworks and enhance supply of quality skilled healthcare personnel. It was to have separate councils for higher education and health.

The process gathered momentum in 2010 when the MCI president was arrested and the government took over its functioning by appointing a seven-member BoG through an ordinance. This was initially meant for a period of one year but the arrangement continued until 2013.

In the meanwhile, the NCHRH Bill of 2011 was introduced for establishing a new regulatory body but a Parliamentary panel that examined it suggested that it should be withdrawn and redrafted after addressing apprehensions of the stakeholders.

The government's failure to follow appropriate legal processes in 2013 led to the revival and reconstitution of the MCI in its old form, which continued till 2018. In meanwhile, fresh corruption cases surfaced against the regulatory body, which reached the Supreme Court and led to constitution of an oversight committee (OC) to look after its affairs twice. In 2018, the second OC resigned alleging non-compliance of its instructions by the MCI. This led to its second take over by the government in September 2018, which it did through an ordinance.

By the time, the government had introduced the NMC Bill of 2017 in the Lok Sabha, proposing an alternative to the MCI (unlike the overarching body of NCHRH). This Bill too ran into trouble for several reasons. These included lack of representational character of the NMC (regarding elected medical professionals and the state medical bodies), powers relating to fee structures of private medical colleges and also for proposing a "bridge course" for the AYUSH - Ayurveda, yoga and naturopathy, unani, siddha and homoeopathy - practitioners to also let them practice and prescribe allopathic medicines (modern medicines).

The NMC Bill was examined by a Parliamentary panel which recommended several changes, including several measures to improve its representational character and also suggested that the bridge course for the AYUSH practitioners should not be made mandatory - which the government later accepted. The NMC Bill, however, could not be taken up again and lapsed with the 16th Lok Sabha.

Why IMA is against the IMC Bill of 2019

The Indian Medical Association (IMA) - the apex body representing medical fraternity in India - has been strongly protesting against the government takeover of the MCI.

Former IMA president Dr. KK Aggarwal says taking away the autonomy of any regulatory body is not in the interest of society or democracy. He says, "Just as you can't run the Parliament through Cabinet decisions alone or without the approval of both the Houses, you require the MCI's executive body and council to run it". As for the corruption charges against in MCI, he says the government can fix it if it wants through appropriate action, without necessarily taking away its autonomy.

Dr. Vinay Aggarwal, another former IMA president, also echoes similar sentiments. He is opposed to the NMC, which is supposed to replace it, in its present design, saying that such a body must have democratic and representational characters and function independent of government.

Ten years is a long time for the government to fix a regulatory mechanism. When it involves healthcare, the government should be more alert and careful. More than ordinances and their replacement Bills, as has been the case for the past 10 years, the government should look for long term solution through planning and consultations.