A recent National Medical Commission (NMC) notification staying the opening of new medical colleges in the country has stirred a hornet’s nest. The Tamil Nadu government has alleged that it has created a regressive situation and should be stayed.
In a letter to the centre, Tamil Nadu Chief Minister MK Stalin said that due to the notification, there was a danger in the situation becoming like it was many years ago. He said that instructions should be given to the health ministry to keep this notification suspended. He said the centre should begin consultation with states in this matter.
He said that letters of permission will not be issued to all the colleges from 2023-2024. He told the centre that only colleges with an annual capacity of 50/100/150 seats will be allowed, as per the NMC. A condition has also been laid down to have a ratio of 100 MBBS seats per 10 lakh population in a state or Union Territory.
Stalin described this notification as a “direct encroachment” and said, the NMC’s decision was tantamount to punishing those states which have been investing heavily and consistently over the last several years in strengthening the public health infrastructure and network of government hospitals.
Tamil Nadu is one state that gives priority to development. He also said that continuous efforts have been made to strengthen the network of government health centres for the last several decades. The result is that there was no shortage of doctors and nurses in the state. He claimed that Tamil Nadu’s excellent performance on various parameters of the health sector was not hidden from anyone.
Stalin stated that Chennai was called the healthcare capital of India. He said that doctors and medical professionals were providing excellent services in government and private hospitals of the state. He said that apart from Tamil Nadu, patients coming for treatment from other states and even outside the country got good health services.
According to the NMC notification, a high doctor, patient ratio was necessary to open a medical college. He said that there were enough doctors in Tamil Nadu at the state level, but there were many districts where their availability remains a major problem. Referring to the measures to overcome the problem of shortage of hospitals, Stalin said that this crisis can be effectively overcome only by starting new medical colleges in backward areas. Any restriction imposed by the NMC based on state-level norms would deprive those districts of good hospitals where health infrastructure can be developed.
He said that the doctor-population ratio was high in a state like Tamil Nadu. The main reason for this was investment by the state government and the private sector.
However, there was no investment from the central government, Stalin alleged. He said the state had been continuously insisting that the central government needs to contribute more, but projects like All India Institute of Medical Sciences in Madurai had not started yet.
Given the current situation, restrictions on the opening of new institutions would put Tamil Nadu at risk in the health sector. He said that if the NMC notification was not stopped, the possibilities of central investment in the state may be completely destroyed.
He said the Supreme Court had also accepted in a September 2022 decision that restrictions cannot be imposed on fundamental rights on the basis of executive instructions. Stalin said it was a fundamental right to establish educational institutions under Article 19(1)(g) of the Constitution.
In the light of the Supreme Court order, the NMC notification can be legally rejected, he said. Considering all the issues, the health ministry should be directed to keep the notification in abeyance and consultation with state governments on opening medical colleges should be started, he said.
The notification said that in exercise of the powers conferred through sub-section (a), (d) and (e) of Section 24 read with Sections 26, 28 and 29 of the National Medical Commission Act, 2019 (Act 30 of 2019), the Under Graduate Medical Education Board hereby issues the following detailed “Guidelines under Regulation 10 of the Establishment of New Medical Institutions, Starting of New Medical Courses, Increase of Seats for Existing Courses & Assessment and Rating Regulations, 2023 in short (UG-MSR 2023)” and Regulation 19 of the Graduate Medical Education Regulations 2023.
According to the notification, “these regulations are to prescribe for a medical college and Medical Institution approved for admissions of MBBS students annually, the minimum requirements of accommodation in the college and its associated teaching hospitals, staff (teaching and technical) and equipment in the college departments and hospitals”.
These regulations shall be applicable to medical colleges being established from the academic session 2024-25 onwards.
(1) Applications for establishing new undergraduate medical education colleges shall be allowed only for 50/100/150 seats.
(2) Only colleges meeting these requirements shall be eligible for continuing their admission of permitted/recognised number of MBBS students from the academic year 2024-2025.
(3) Colleges seeking an increased number of seats cannot exceed a total of 150 MBBS.
(4) Colleges seeking an increase in seats shall have admitted batches fulfilling all the criteria for the preceding academic year and also shall be fulfilling all the requirements for increase in seat capacity.
(5) With the exception that colleges who have applied for the academic year 2023-24 for increased seats, but failed to get it, can ask for the same number (totalling 200 or 250) that was in their previous application for one time 2024-25 only.
(6) After 2023-24, a letter of permission (LOP) for starting of new medical colleges shall be issued only for an annual intake capacity of 50/100/150 seats, provided that the medical college shall follow the ratio of 100 MBBS seats for 10 lakh population in that state/UT.
Every hospital seeking permission to start a medical college after the publication of this amended regulation shall comprise the medical college, attached teaching hospital/(s) and hostels for the students and interns, with or without the residential area for faculty and other staff.
The medical college, hostels for students/interns and the teaching hospital/institution shall be either in a unitary campus or maximum of two campuses.
Each unitary campus shall have adequate constructed area on the land, as per the prevalent building norms, belonging to the college management or if on lease, at least for a period of 30 years on lease.
If there are two plots/campuses, then the college shall be in a single plot. The distance between the plots of the college and hospital shall have a travel time of a maximum of 30 minutes. The hospital shall have at least 220 beds.
There should be adequate accommodation for the principal/dean, college council, academic and examination sections, accounts and other administrative offices (as per the need), the medical education unit and the server room for the computer network.
The college council shall comprise the head of departments as members and the principal/dean as chairperson.
The council shall meet at least four times in a year to draw up the details of curriculum and training programmes, enforcement of discipline and other academic matters. There shall be a central library (preferably air-conditioned) with good lighting and adequate space for stocking of books and journals.
—By Adarsh Kumar and India Legal Bureau