THE HONBLE SRI JUSTICE RAMESH RANGANATHAN AND THE HONBLE SRI JUSTICE M.
WRIT PETITION NO.5784 OF 2014
31-12-2014
Dr.P.Harsha Vardhan and others.Petitioner
Government of India, Ministry of Health & Family Welfare and others..
Respondents
Counsel for the petitioner: Sri A. Sanjeev Kumar
Counsel for respondents: Govt. of India, Ministry of Health;
Sri A. Prabhakar Rao; Sri D. Srinivas,
Learned Standing Counsel for MCI
<GIST:
>HEAD NOTE:
? Citations:
1) AIR 1956 SC 479
2) (1999) 7 SCC 120
3) (2003) 8 SCC 69
4) (1981) 4 SCC 512
5) AIR 1958 SC 538
6) (1994) 6 SCC 349
7) (1974) 1 SCC 19 = AIR 1974 SC 1
8) AIR 1967 SC 839
9) AIR 1968 SC 1099
10) AIR 1955 SC 191
11) 1952 SCR 284
12) (2002) 3 SCC 302
13) (2002) 4 SCC 539
14) (2014) 8 SCC 390
15) (1974) 4 SCC 428
16) 1989 Suppl. (1) SCC 116
17) (1994) 3 SCC 569
18) (2004) 3 SCC 609
19) (2010) 3 SCC 314
20) (2011) 2 SCC 575
21) (2011) 9 SCC 1
22) (2002) 2 SCC 7
23) (2002) 8 SCC 715
24) (2004) 10 SCC 796
25) (2009) 5 SCC 641
26) (2011) 4 SCC 606
27) (1980) 3 SCC 97
28) (2011) 8 SCC 737
29) AIR 1965 SC 491
30) AIR 1990 SC 1402
31) AIR 2010 SC 1285
32) (2010) 8 SCC 372
33) (2011) 6 SCC 597
34) (1984) 4 SCC 27
35) AIR 1974 SC 1631
THE HONBLE SRI JUSTICE RAMESH RANGANATHAN
AND
THE HONBLE SRI JUSTICE M.SATYANARAYANA MURTHY
WRIT PETITION No.5784 OF 2014
ORDER: (per Honble Sri Justice Ramesh Ranganathan)
This Writ Petition is filed to declare the action of the Medical
Council of India (MCI for short) in exercising its powers under
Section 33 of the Indian Medical Council Act, 1956 (hereinafter
called the Act) and amending the Post Graduate Medical
Education Regulations, 2000 (hereinafter called the Regulations)
by notification dated 17.04.2013, and thereby deleting M.D
(Biochemistry) discipline from the eligibility criteria for admission
to the super-specialty course of Doctor of Medicine (DM) in
Endocrinology, as arbitrary, illegal and in violation of Article 14 of
the Constitution of India.
The petitioners have all either completed their post graduate
degree (MD) in Bio-chemistry or are undergoing the said course.
By notification dated 17.04.2013, the MCI amended the
Regulations deleting M.D (Biochemistry) from among the
prescribed eligibility criteria for admission to DM (Endocrinology)
super specialty course. It is the petitioners case that they opted
for M.D (Bio-chemistry) having regard to their future prospects of
becoming an Endocrinologist by pursuing DM (Endocrinology) as a
super specialty subject; prior to its amendment, the Regulations
prescribed M.D (Biochemistry), M.D (Pediatrics) and M.D (General
Medicine) as the minimum educational qualifications required for
admission to DM (Endocrinology); these Regulations were in
existence for more than 13 years till they were amended in the year
2013; in its 33rd meeting held on 03.10.2013, the Board of
Governors of MCI resolved that MD (Biochemistry) be deleted as
the entry qualification for admission to D.M. (Endocrinology), as
M.D (Biochemistry) was a preclinical discipline wherein candidates
were not exposed to clinical practice; extensive clinical knowledge
was necessary to pursue DM (Endocrinology) which dealt with the
endocrine system of the body; they had retained the other two
disciplines i.e., M.D (General Medicine) and M.D (Pediatrics) on the
ground that these two disciplines were essentially clinical subjects,
which dealt with the clinical aspects of the endocrine system in
adults and children; this finding of the Board of Governors is
incorrect; while clinical practice is necessary for pursuing
endocrinology, it cannot be said that M.D (Biochemistry) course
does not have any clinical subjects or that candidates possessing a
post-graduate degree in Biochemistry are not exposed to clinical
subjects at all; the very fact that the candidates, possessing M.D
(Biochemistry), were allowed to pursue D.M (Endocrinology) for the
past 13 years shows that they were also exposed to clinical
subjects during their MBBS programme; if M.D (Biochemistry) is
deleted as one of the eligible qualifications, for admission into DM
(Endocrinology), Post-Graduates in Biochemistry would be unable
to undergo any other super- specialty course except in
Immunology and Genetics for which no seats are available in the
State of Andhra Pradesh; though these two disciplines are being
taught in other States, candidates belonging to the State of Andhra
Pradesh are not eligible to undergo the said course; consequently,
all candidates who possess the qualification of M.D (Biochemistry)
would be required to stop further education in medicine, and rest
content only with a post graduate degree; candidates are being
eliminated from appearing in the entrance examination, for
admission into D.M (Endocrinology), in the midst of their M.D
(Biochemistry) course; they cannot even stop pursuing the MD
(Biochemistry) course, as they have to lose their Rupees 20 lakhs
bond which they gave at the time of admission; even if they were to
complete MD (Biochemistry), they cannot pursue another Post
Graduation course thereafter to seek admission into DM
(Endocrinology), as it is not permissible in law to have two Post-
Graduate Degrees/Diplomas; the M.C.I cannot exclude M.D
(Biochemistry) abruptly without prior intimation to the student
community; before taking a decision to delete MD (Biochemistry),
as one of the eligible subjects for admission into DM
(Endocrinology), MCI has not examined the repercussions and the
plight of students who are either pursuing M.D. (Biochemistry) or
have completed the said course; earlier MCI and various
universities had allowed students with M.D (Biochemistry) to seek
admission to D.M (Endocrinology); even during their MBBS and
Post Graduate programme in Biochemistry with rotatory
internship, students are given adequate exposure in clinical
subjects; the student logbook itself substantiates that M.D
(Biochemistry) students are posted in areas where they are given
adequate clinical exposure; while undergoing the post graduate
degree course in Biochemistry, students are required to examine
patients, undertake laboratory diagnosis and treatment etc; the
impugned amendment is an abuse of the power vested in the MCI
under Section 33 of the Act; before amending the regulations, by
deleting M.D (Biochemistry) from the eligible post-graduate courses
necessary for admission into DM (Endocrinology), the M.C.I. has
neither undertaken any scientific study nor has it considered the
adverse impact their decision would have on students pursuing
M.D (Biochemistry); having permitted students with M.D
(Biochemistry) to pursue DM (Endocrinology) for the past 13 years,
M.C.I. has acted arbitrarily in deleting/eliminating them from the
stream of students eligible to appear for the entrance examination
for admission into DM (Endocrinology) course; and this action of
the respondent is arbitrary and illegal.
In the counter-affidavit filed on behalf of the 2nd respondent
it is stated that M.C.I, constituted under the provisions of Indian
Medical Counsel Act, has been entrusted with the responsibility of
maintaining the highest standards of medical education through
out the country; in the discharge of these statutory obligations,
M.C.I. has been empowered, with the prior approval of the Central
Government, to frame regulations for laying down the minimum
standards of infrastructure, teaching and other requirements for
conducting medical courses; the M.C.I. lays down in detail the
course content, the duration, distribution of teaching and training
on various subjects, and the manner in which examinations
should be conducted etc; the Regulations framed by M.C.I are
statutory in character, and have the force of law; the Post-
Graduate Medical Education Regulations, 2000 were approved by
the Government of India on 22.05.2000, and were published in the
official gazette on 07.10.2000, with the prior approval of the
Central Government; these regulations were amended whereby the
procedure for admission in post graduate courses has been
prescribed in detail; these regulations provide that admission, in
post graduate medical courses, must be on the basis of merit, and
merit alone; the mandatory and binding character of the statutory
regulations have been upheld by Courts; the Courts would not,
normally, interfere with the qualifications prescribed by expert
bodies like the M.C.I, especially for admission into super-specialty
medical courses; the M.C.I was superseded by the Board of
Governors, nominated by the Central Government, in May, 2010;
the entire work of M.C.I was carried out thereafter by the Board of
Governors, who later demitted office in November, 2013; the Board
of Governors, nominated by the Central Government, constituted a
Speciality Board to re-examine the eligibility criteria for admission
into various super-specialty courses including D.M (Endocrinology)
as provided under the Post Graduate Medical Education
Regulations, 2000; the three members of the Speciality Board, who
are eminent specialists in the field of medicine and in the
concerned super-specialty of Endocrinology, were (i) DR. Nalini
Sameer Shah, Professor & Head of the Department of
Endocrinology, Seth G.S. Medical College, K.E.M. Hospital, Parel,
Mumbai; (ii) Dr. Krishna G. Sheshadri, Professor and Head of
Endocrinology and Diabetes at Sri Ramachandra University,
Chennai and (iii) Dr. Nikhil Tandon, Professor & Head of the
Department of Endocrinology, AIIMS, New Delhi; the members of
the Specialty Board, after detailed discussion and due
deliberations with regards the eligibility criteria for admission into
the D.M. (Endocrinology) super specialty course, unanimously
agreed that prior experience as a clinician is required for pursuing
the D.M (Endocrinology) course which is a clinical discipline; the
recommendations of the specialty board was placed before the
Board of Governors, nominated by the Central Government, in
their meeting held on 11.06.2012; after due deliberations, with
regards the eligibility criteria for admission into D.M.
(Endocrinology) course, the Board of Governors agreed with the
recommendations of the Specialty Board; a draft notification was
sent to the Central Government on 29.06.2012 for its approval;
after scrutinizing the proposed amendment in the Schedule to the
Post Graduate Medical Education Regulations, 2000, the Central
Government duly approved the same; thereafter the notification
was sent for publication in the gazette; the M.C.I. has amended the
regulations with the prior approval of the Central Government; the
amendment to the regulations dated 17.04.2013 was notified in
the gazette on 15.05.2013; after the amendment, all candidates
desirous of admission in the super-specialty D.M (Endocrinology)
course must have obtained a post-graduate degree, from a
recognized medical college, either in Medicine or in Pediatrics;
candidates possessing the post-graduate medical qualification in
Biochemistry are eligible for admission into other super-specialty
medical course such as D.M (Clinical Hematology), D.M.
(Immunology) and D.M. (Medical Genetics); the petitioners
contention that, after the amendment dated 17.04.2013, they
cannot pursue a super specialty course is misconceived; the
amendment dated 17.04.2013 is not unreasonable, discriminatory
or in violation of Article 14 of the Constitution of India; with a view
to discharge its statutory responsibilities under the Act, the M.C.I.
has, from time to time, framed and amended various regulations
with the prior approval of the Central Government for laying the
minimum norms and requirements; and the petitioners are not
entitled to the relief sought for.
Sri A. Sanjeev Kumar, Learned Counsel for the petitioner,
would submit that, ever since the Regulations were made in the
year 2000 till the year 2013 when the amended Regulations came
into force, M.D. (Biochemistry) was among the prescribed
educational qualifications for admission into the DM
(Endocrinology) super speciality course; the MCI has not assigned
any reasons for deleting M.D. (Biochemistry) from the prescribed
eligibility criteria for admission into D.M. (Endocrinology); the
deletion of M.D. (Biochemistry) is discriminatory, and in violation
of Article 14 of the Constitution of India; the report of the Specialty
Board does not disclose any valid reasons for deletion of the M.D.
(Biochemistry) course; the averment in the counter-affidavit that
students undergoing a post graduate course in Biochemistry are
not exposed to clinical subjects is erroneous; a perusal of the
syllabus, enclosed along with the Writ Petition, shows that
students undergoing M.D. (Biochemistry) course are exposed to
clinical subjects also; students who possess M.D. (Biochemistry)
qualification are similarly situated to those who have completed a
postgraduate degree course in Medicine or Pediatrics; students
who possess postgraduate qualification in these three courses are
similarly situated; retention of M.D. (medicine) and M.D.
(Pediatrics), while deleting M.D. (Biochemistry), as the eligible
qualification for admission into D.M. (Endocrinology) does not
satisfy the test of a valid classification; and it is arbitrary,
discriminatory and illegal. Learned Counsel would rely on Bidi
Supply Co. v. Union of India in this regard.
The Postgraduate Medical Education Regulations, 2000 were
made by the Medical Council of India in the exercise of its powers
under Section 33 of the Indian Medical Council Act, 1956. In the
Schedule thereto, the eligibility criteria stipulated for admission in
D.M. (Endocrinology) course was that the candidate must possess
a recognised degree (or its recognised equivalent degree) in M.D.
(medicine), M.D. (Pediatrics), and M.D. (Biochemistry). The
Regulations were amended by the Postgraduate Educational
Amendment Regulation 2012 and, in the schedule to the
Postgraduate Medical Education Regulations, 2000 under the head
D.M (doctor of medicine) for endocrinology at serial No.4, M.D.
(Biochemistry) was deleted. Consequent thereto, it is only
students, who possess a Post-graduate degree in Medicine or
Pediatrics, who are eligible to seek admission into D.M
(Endocrinology) super specialty course. The aforesaid amendment
to the Regulations were made, with the approval of the Central
Government, on 17.04.2013 and were published in the Gazette of
India dated 15.05.2013. For admission into the D.M
(Endocrinology) course, after the amendment was published in the
gazette on 15.05.2013, candidates, who possess a postgraduate
degree in Biochemistry, are no longer eligible.
The MCI has been set up as an expert body, under the
Indian Medical Council Act, 1956, to control the minimum
standards of medical education and to regulate their observance.
The Act empowers the MCI to prescribe the minimum standards of
postgraduate medical education; and it has implicit power to
supervise the qualifications or eligibility standards for admission to
medical institutions. The universities are guided by the standards
prescribed by the Medical Council. The Medical Council
Regulations have statutory force and are mandatory. (Dr.Preeti
Srivastava v. State of M.P. ; Harish Verma v. Ajay Srivastava ;
State of Kerala v. T.P. Roshana ). The validity of these statutory
regulations can only be impeached on the ground that it falls foul
of the parent Act or it is in violation of the constitutional
provisions, more particularly Part III of the Constitution of India. It
is not even the case of the petitioners that the amended Regulation
is in violation of the provisions of the Act. The challenge thereto is
limited to its being discriminatory and ultravires Article 14 of the
Constitution of India.
It must be presumed that the Legislature understands and
correctly appreciates the need of its own people, that its laws are
directed to problems made manifest by experience and that its
discriminations are based on adequate grounds. There is always a
presumption in favour of the constitutionality of an enactment,
and the burden is upon him who attacks it to show that there has
been a clear transgression of the constitutional principles. (Ram
Krishna Dalmia v. Justice S.R. Tendolkar ; Gauri Shanker v.
Union of India ). There is always a presumption in favour of the
constitutionality of an enactment/rule/regulation and the burden
is upon him who attacks it to show that there has been a clear
transgression of the constitutional principles. A rule cannot be
struck down as discriminatory on any a priori reasoning. Where a
party seeks to impeach the validity of a rule made by a competent
authority on the ground that the Rules offend Article 14, the
burden is on him to plead and prove the infirmity. The burden is
on the petitioner to set out facts necessary to sustain the plea of
discrimination and to adduce cogent and convincing evidence to
prove those facts for there is a presumption that every factor
which is relevant or material has been taken into account in
formulating the classification. Unless the classification is unjust
on the face of it, the onus lies upon the party attacking the
classification to show, by pleading and placing the necessary
material before the Court, that the said classification is
unreasonable and violative of Article 14 of the Constitution.(State
of J & K v. Triloki Nath Khosa ; G.D. Kelkar v. Chief Controller
of Imports and Exports ). It is no part of the respondents burden
to justify the classification or to establish its constitutionality.
(Triloki Nath Khosa7).
In order to establish that the protection of the equal
opportunity clause has been denied to them, it is not enough for
the petitioners to say that they have been treated differently from
others, not even enough that a differential treatment has been
accorded to them in comparison with others similarly
circumstanced. Discrimination is the essence of classification and
does violence to the constitutional guarantee of equality only if it
rests on an unreasonable basis. It is, therefore, incumbent on the
petitioners to show that the classification of students into those
who hold a postgraduate medical degree either in Medicine or
Pediatrics, and those who hold a postgraduate medical degree in
Biochemistry, is unreasonable and bears no rational nexus with its
purported object. (Triloki Nath Khosa7). The submission, urged
on behalf of the petitioners in this regard, is only that the MCI had
erred in holding that post graduates in Biochemistry, unlike post
graduates in Medicine and Pediatrics, do not have clinical
experience.
In examining this contention, it must be borne in mind that
Article 14 forbids discrimination, and its gravamen is equality of
treatment. A person setting up a grievance of denial of equal
treatment by the law must establish that, between persons
similarly circumstanced, some were treated to their prejudice and
the differential treatment has no reasonable relation to the object
sought to be achieved by the law. (Gauri Shanker6; Western U.P.
Electric Power & Supply Co. Ltd. v. State of U.P. ). While
Article 14 forbids class legislation, it does not forbid reasonable
classification for the purposes of legislation. In order, however, to
pass the test of permissible classification two conditions must be
fulfilled, namely, (i) that the classification must be founded on an
intelligible differentia which distinguishes persons or things that
are grouped together from others left out of the group, and (ii) that
the differentia must have a rational relation to the object sought to
be achieved by the statute in question. The classification may be
founded on different basis. What is necessary is that there must
be a nexus between the basis of classification and the object of the
Act/Regulation under consideration. (Gauri Shanker6; Ram
Krishna Dalmia5; Budhan Choudhry v. State of Bihar ). The
classification must rest upon a real and substantial distinction
bearing a reasonable and just relation to the thing in respect to
which the classification is made; and classification made without
any reasonable basis should be regarded as invalid. (Bidi Supply
Co.1; State of West Bengal v. Anwar Ali Sarkar ).
The complaint, of violation of Article 14 of the Constitution,
cannot be judged by adopting a doctrinaire approach. It is not
prudent or pragmatic to insist on a mathematically accurate
classification covering diverse situations and all possible
contingencies in view of the inherent complexities involved. (State
of Karnataka v. Mangalore University Non-Teaching Employees
Association ). The legislature enjoys considerable latitude, and
exercises its power of classification enriched by its experience and
taking into consideration myriad circumstances. (Ombalika Das
v. Hulisa Shaw ). Precision and arithmetical accuracy will not
exist in any categorisation, and such precision and accuracy is not
what Article 14 contemplates. As long as the broad features of the
categorisation are identifiable and distinguishable, and the
categorisation is reasonably connected with the object targeted,
Article 14 does not forbid such a course of action. (Subramanian
Swamy v. Raju ; Murthy Match Works v. CCE ; Roop Chand
Adlakha v. DDA ; Kartar Singh v. State of Punjab ; Basheer v.
State of Kerala ; B. Manmad Reddy v. Chandra Prakash
Reddy and Transport and Dock Workers Union v. Mumbai
Port Trust ).
The object sought to be achieved by the classification, in the
amended Regulations, is to further excellence in higher Medical
Education. The basis of classification of students, between those
who have a post graudate degree in medicine and pediatrics on the
one hand, and those having a post graduate degree in
Biochemistry on the other, for admission in D.M. (Endocrinology) is
their clinical experience. While the former group are said to have
the requisite clinical experience, the latter are said not to. As the
classification of post-graduate Medical students, between those
who have the required clinical experience and those who do not,
has a reasonable nexus to the object sought to be achieved i.e.,
maintenance of high standards of Medical Education by restricting
admission to DM (Endocrinology) course only to those students
who have the required clinical exposure, the test of a valid
classification is satisfied, and the petitioners plea of discrimination
must fail.
The contention, that no reasons are assigned for amending
the regulations, is also devoid of merit. Delegated legislation
cannot be questioned on the ground of violation of the principles of
natural justice, especially in the absence of any such statutory
requirement. Neither the Legislature nor its delegate are legally
obliged to give any reasons for their action while discharging their
legislative function. (K.T. Plantation Pvt. Ltd. v. State of
Karnataka ; State of Punjab v. Tehal Singh ; W.B. Electricity
Regulatory Commission v. CESC Ltd. ; Pune Municipal Corpn.
v. Promoters and Builders Assn. and Bihar SEB v. Pulak
Enterprises ). The basis of the classification of persons or things
may appear on the face of the statute or may be gathered from the
surrounding circumstances known to or brought to the notice of
the Court. (Ram Krishna Dalmia5; Gauri Shanker6).
Relevant material is always admissible to show the reason
and the justification for the classification. Such reasons need not
appear on the face of the Rule or the law which effects the
classification. (T.N. Khosa7). The reasons, which necessitated
amendment of the Regulations, are detailed in the counter-affidavit
filed on behalf of MCI, and are evident from the record placed for
our perusal, which include the report of the speciality board
consisting of three eminent Endocrinologists in the country. In the
absence of any such requirement, either in the parent Act or in the
Regulations themselves, the reasons which necessitated
amendment of the Regulations need not be reflected in the
Regulations itself and can be gathered from the surrounding
circumstances or, for that matter, can be stated in the counter-
affidavit filed before this Court.
The mere fact that M.D. (Biochemistry) was among the
prescribed qualifications for admission into D.M. (Endocrinology)
for thirteen years, from when the Regulations were made in the
year 2000 till they were amended in the year 2013, is of no avail.
The eligibility criteria for admissions in super-speciality medical
courses must be periodically reviewed by the MCI keeping in mind
the need to maintain excellence and high standards in higher
medical education. Determination of such standards is part of the
academic policy of the MCI. (Visveswaraiah Technological
University v. Krishnendu Halder ). Revision of standards, for
admission into super-speciality courses in Medicine, are matters of
policy. The Court cannot strike down a policy merely because
there is a variation. Consistency is not always a virtue. What is
important is to know whether irrational and extraneous factor foul.
(Tamil Nadu Education Deptt. Ministerial & General
Subordinate Services Assn. v. State of T.N. ). There can be no
quarrel if a policy is revised. The wisdom of yesterday may
obsolesce into the folly of today, even as the science of old may
sour into the superstition now, and vice versa. (Tamil Nadu
Education Deptt. Ministerial & General Subordinate Services
Assn.27). Reform must begin somewhere if it has to begin at all
and, therefore, the administrator who has complex problems to
solve must be allowed the freedom to proceed tentatively, step by
step. (T.N. Khosa7). The petitioners cannot be heard to contend
that qualifications, once prescribed, must continue forever and not
be subjected to change at all.
The records placed before this Court by Sri D. Srinivas,
Learned Standing Counsel for MCI, reveal that a Board of Experts
was constituted to examine the course content for D.M.
(Endocrinology). In its report submitted to the Board of Governors
of MCI, the expert committee opined that the goals of the D.M
programme, in Endocrinology, Diabetes and Metabolism, was to
provide comprehensive knowledge, clinical skills, professional
attributes and values to prepare trainees to care for patients
suffering from diseases of the endocrine system; to ensure clinical
care experience to a variety of patients suffering from diverse
endocrine problems, and in diagnosing and managing such
patients; and to provide a diverse learning experience to trainees in
allied areas as they relate to endocrinology, diabetes and
metabolism. The expert body suggested that the name of the
course be renamed as Doctor of Medicine (D.M) in Endocrinology,
Diabetes and Metabolism and the eligibility therefor be prescribed
as a post-graduate degree in M.D (Internal Medicine) or M.D
(Pediatrics) in three years.
While recommending the competence standards for
undergoing the DM (Endocrinology) course, the Board of experts
opined that the postgraduate must demonstrate competence in
clinical care including evaluation and management of horomonal
problems, acute life threatening complications of hyper and hypo
glycemia; metabolism in adults and children, and other aspects of
Endocrinology and Metabolism. The emphasis placed by the
expert body was on competence in clinical care in various
areas/aspects. As the expert body was of the view that such
clinical exposure is given only to those students who undergo a
post-graduate degree course in internal Medicine or in Pediatrics,
the eligibility criteria for admission into D.M (Endocrinology) was
restricted only to these courses. On receipt of the
recommendations of the expert body the M.C.I, after complying
with the requirements of Section 33 of the Act, deleted M.D
(Biochemistry) from among the educational qualifications
prescribed as the eligibility criteria for admission into the D.M
(Endocrinology) super specialty course.
The contention that Medical post-graduates in Biochemistry
have the required clinical exposure cannot be examined in writ
proceedings under Article 226 of the Constitution of India. The
Court lacks the expertise to examine academic policies and would,
ordinarily, abide by the opinion of experts. Courts should be slow
to interfere with the opinions expressed by experts, and must leave
such decisions to those who are more familiar with such problems,
than the Courts generally can be. (State of T.N. v. K. Shyam
Sunder ; University of Mysore v. C.D. Govinda Rao ; Neelima
Misra v. Harinder Kaur Paintal ; Victoria Memorial Hall v.
Howrah Ganatantrik Nagrik Samity ; Basavaiah (Dr.) v. Dr.
H.L. Ramesh and State of H.P. v. H.P. Nizi Vyavsayik
Prishikshan Kendra Sangh ). Whether or not students who have
undergone M.D. (Biochemistry) course have been given clinical
exposure on par with those who have undergone M.D. (Medicine)
or M.D (Pediatrics) courses, are matters of expertise which this
Court lacks, and are technical questions not, ordinarily, amenable
to judicial review.
The Court would not substitute its opinion for that of the
Legislature or its delegate as to what policy would best serve the
objects and purposes of the Act or sit in judgment over the wisdom
and effectiveness or otherwise of the policy laid down by the
regulation-making body, and declare a regulation to be ultravires
merely on the ground that, in the view of the Court, the impugned
provisions will not help to serve the object. As long as the body,
entrusted with the task of framing the rules or regulations, acts
within the scope of the authority conferred on it, in the sense that
the rules or regulations made by it have a rational nexus with the
object, the court would not concern itself with the wisdom or
efficaciousness of such rules or regulations. It is exclusively within
the province of the Legislature and its delegate to determine, as a
matter of policy, what measures would have to be incorporated in
the rules or regulations for the efficacious achievement of the
objects.
It is not for the Court to examine the merits or demerits of a
policy. (Maharashtra State Board of Secondary and Higher
Secondary Education v. Paritosh Bhupeshkumar Sheth ). It
may be a wise policy which will effectuate the purpose of its
enactment or it may lack effectiveness calling for its revision and
improvement. Any drawbacks in the policy, incorporated in a rule
or regulation, will not render it ultra vires and the Court would not
strike it down on the ground that, in its opinion, it is not a wise or
prudent policy. The Legislature and its delegate are the sole
repositories of the power to decide what policy should be pursued
in relation to matters covered by the Act. (Maharashtra State
Board of Secondary and Higher Secondary Education34).
Equivalence of educational qualifications is a technical
question based on a proper assessment and evaluation of the
relevant academic standards and practical attainments of such
qualifications, and where the decision is based on the
recommendation of an expert body which possesses the requisite
knowledge, skill and expertise for adequately discharging such
functions, the Court, uninformed of relevant data and unaided by
the technical insights necessary for the purpose of determining
equivalence, would not lightly disturb the decision. It is only where
the decision is shown to be based on extraneous or irrelevant
considerations or is actuated by malafides or is irrational and
perverse or is manifestly wrong that the Court would reach out its
lethal arm and strike down the decision. (Mohd. Shujat Ali v.
Union of India ). The Court would not sit in appeal over the
legislative judgment to find out whether, on a comparative
evaluation of the rival theories touching upon the question of
equivalence in educational qualifications, the theory advocated by
the petitioners is not to be preferred. Classification is primarily for
the legislature or for the statutory authority charged with the duty
of framing the eligibility criteria and if, looked at from the
standpoint of the authority making it, the classification is found to
rest on a reasonable basis, it has to be upheld. (Triloki Nath
Khosa7). This Court would defer to the wisdom of the Speciality
Board whose members are experts in the field of Endocrinology,
more so as no malafides are attributed to them, and their expertise
in this regard is not in doubt.
The contention that deletion of M.D. (Biochemistry), from the
list of eligible educational qualifications required for admission into
D.M (Endocrinology) course, would deny the petitioners the
opportunity of undergoing any super speciality course, does not
also merit acceptance. It is evident, from the counter-affidavit filed
on behalf of the MCI, that M.D (Biochemistry) is among the
prescribed educational qualifications for admission into the super
speciality courses of D.M (clinical Hematology), DM (Immunology)
and D.M (Medical genetics). The M.C.I. lays down uniform
standards for medical education applicable to all the universities
throughout the country and the petitioners, some of whom are
undergoing their post graduation in Biochemistry in the States of
Telangana and Andhra Pradesh, cannot claim to stand on a
different footing. While the amendment to the Regulations has
resulted in their being denied the opportunity of undergoing the
D.M (Endocrinology) course, that, by itself, would not justify
striking down the statutory regulations, which are otherwise valid.
Viewed from any angle, the petitioners are not entitled to the
relief sought for. The Writ Petition fails and is, accordingly,
dismissed. The miscellaneous petitions pending, if any, shall also
stand dismissed. No costs.
_____________________________
RAMESH RANGANATHAN, J
___________________________________
M. SATYANARAYANA MURTHY, J
Date: 31-12-2014.
WRIT PETITION NO.5784 OF 2014
31-12-2014
Dr.P.Harsha Vardhan and others.Petitioner
Government of India, Ministry of Health & Family Welfare and others..
Respondents
Counsel for the petitioner: Sri A. Sanjeev Kumar
Counsel for respondents: Govt. of India, Ministry of Health;
Sri A. Prabhakar Rao; Sri D. Srinivas,
Learned Standing Counsel for MCI
<GIST:
>HEAD NOTE:
? Citations:
1) AIR 1956 SC 479
2) (1999) 7 SCC 120
3) (2003) 8 SCC 69
4) (1981) 4 SCC 512
5) AIR 1958 SC 538
6) (1994) 6 SCC 349
7) (1974) 1 SCC 19 = AIR 1974 SC 1
8) AIR 1967 SC 839
9) AIR 1968 SC 1099
10) AIR 1955 SC 191
11) 1952 SCR 284
12) (2002) 3 SCC 302
13) (2002) 4 SCC 539
14) (2014) 8 SCC 390
15) (1974) 4 SCC 428
16) 1989 Suppl. (1) SCC 116
17) (1994) 3 SCC 569
18) (2004) 3 SCC 609
19) (2010) 3 SCC 314
20) (2011) 2 SCC 575
21) (2011) 9 SCC 1
22) (2002) 2 SCC 7
23) (2002) 8 SCC 715
24) (2004) 10 SCC 796
25) (2009) 5 SCC 641
26) (2011) 4 SCC 606
27) (1980) 3 SCC 97
28) (2011) 8 SCC 737
29) AIR 1965 SC 491
30) AIR 1990 SC 1402
31) AIR 2010 SC 1285
32) (2010) 8 SCC 372
33) (2011) 6 SCC 597
34) (1984) 4 SCC 27
35) AIR 1974 SC 1631
THE HONBLE SRI JUSTICE RAMESH RANGANATHAN
AND
THE HONBLE SRI JUSTICE M.SATYANARAYANA MURTHY
WRIT PETITION No.5784 OF 2014
ORDER: (per Honble Sri Justice Ramesh Ranganathan)
This Writ Petition is filed to declare the action of the Medical
Council of India (MCI for short) in exercising its powers under
Section 33 of the Indian Medical Council Act, 1956 (hereinafter
called the Act) and amending the Post Graduate Medical
Education Regulations, 2000 (hereinafter called the Regulations)
by notification dated 17.04.2013, and thereby deleting M.D
(Biochemistry) discipline from the eligibility criteria for admission
to the super-specialty course of Doctor of Medicine (DM) in
Endocrinology, as arbitrary, illegal and in violation of Article 14 of
the Constitution of India.
The petitioners have all either completed their post graduate
degree (MD) in Bio-chemistry or are undergoing the said course.
By notification dated 17.04.2013, the MCI amended the
Regulations deleting M.D (Biochemistry) from among the
prescribed eligibility criteria for admission to DM (Endocrinology)
super specialty course. It is the petitioners case that they opted
for M.D (Bio-chemistry) having regard to their future prospects of
becoming an Endocrinologist by pursuing DM (Endocrinology) as a
super specialty subject; prior to its amendment, the Regulations
prescribed M.D (Biochemistry), M.D (Pediatrics) and M.D (General
Medicine) as the minimum educational qualifications required for
admission to DM (Endocrinology); these Regulations were in
existence for more than 13 years till they were amended in the year
2013; in its 33rd meeting held on 03.10.2013, the Board of
Governors of MCI resolved that MD (Biochemistry) be deleted as
the entry qualification for admission to D.M. (Endocrinology), as
M.D (Biochemistry) was a preclinical discipline wherein candidates
were not exposed to clinical practice; extensive clinical knowledge
was necessary to pursue DM (Endocrinology) which dealt with the
endocrine system of the body; they had retained the other two
disciplines i.e., M.D (General Medicine) and M.D (Pediatrics) on the
ground that these two disciplines were essentially clinical subjects,
which dealt with the clinical aspects of the endocrine system in
adults and children; this finding of the Board of Governors is
incorrect; while clinical practice is necessary for pursuing
endocrinology, it cannot be said that M.D (Biochemistry) course
does not have any clinical subjects or that candidates possessing a
post-graduate degree in Biochemistry are not exposed to clinical
subjects at all; the very fact that the candidates, possessing M.D
(Biochemistry), were allowed to pursue D.M (Endocrinology) for the
past 13 years shows that they were also exposed to clinical
subjects during their MBBS programme; if M.D (Biochemistry) is
deleted as one of the eligible qualifications, for admission into DM
(Endocrinology), Post-Graduates in Biochemistry would be unable
to undergo any other super- specialty course except in
Immunology and Genetics for which no seats are available in the
State of Andhra Pradesh; though these two disciplines are being
taught in other States, candidates belonging to the State of Andhra
Pradesh are not eligible to undergo the said course; consequently,
all candidates who possess the qualification of M.D (Biochemistry)
would be required to stop further education in medicine, and rest
content only with a post graduate degree; candidates are being
eliminated from appearing in the entrance examination, for
admission into D.M (Endocrinology), in the midst of their M.D
(Biochemistry) course; they cannot even stop pursuing the MD
(Biochemistry) course, as they have to lose their Rupees 20 lakhs
bond which they gave at the time of admission; even if they were to
complete MD (Biochemistry), they cannot pursue another Post
Graduation course thereafter to seek admission into DM
(Endocrinology), as it is not permissible in law to have two Post-
Graduate Degrees/Diplomas; the M.C.I cannot exclude M.D
(Biochemistry) abruptly without prior intimation to the student
community; before taking a decision to delete MD (Biochemistry),
as one of the eligible subjects for admission into DM
(Endocrinology), MCI has not examined the repercussions and the
plight of students who are either pursuing M.D. (Biochemistry) or
have completed the said course; earlier MCI and various
universities had allowed students with M.D (Biochemistry) to seek
admission to D.M (Endocrinology); even during their MBBS and
Post Graduate programme in Biochemistry with rotatory
internship, students are given adequate exposure in clinical
subjects; the student logbook itself substantiates that M.D
(Biochemistry) students are posted in areas where they are given
adequate clinical exposure; while undergoing the post graduate
degree course in Biochemistry, students are required to examine
patients, undertake laboratory diagnosis and treatment etc; the
impugned amendment is an abuse of the power vested in the MCI
under Section 33 of the Act; before amending the regulations, by
deleting M.D (Biochemistry) from the eligible post-graduate courses
necessary for admission into DM (Endocrinology), the M.C.I. has
neither undertaken any scientific study nor has it considered the
adverse impact their decision would have on students pursuing
M.D (Biochemistry); having permitted students with M.D
(Biochemistry) to pursue DM (Endocrinology) for the past 13 years,
M.C.I. has acted arbitrarily in deleting/eliminating them from the
stream of students eligible to appear for the entrance examination
for admission into DM (Endocrinology) course; and this action of
the respondent is arbitrary and illegal.
In the counter-affidavit filed on behalf of the 2nd respondent
it is stated that M.C.I, constituted under the provisions of Indian
Medical Counsel Act, has been entrusted with the responsibility of
maintaining the highest standards of medical education through
out the country; in the discharge of these statutory obligations,
M.C.I. has been empowered, with the prior approval of the Central
Government, to frame regulations for laying down the minimum
standards of infrastructure, teaching and other requirements for
conducting medical courses; the M.C.I. lays down in detail the
course content, the duration, distribution of teaching and training
on various subjects, and the manner in which examinations
should be conducted etc; the Regulations framed by M.C.I are
statutory in character, and have the force of law; the Post-
Graduate Medical Education Regulations, 2000 were approved by
the Government of India on 22.05.2000, and were published in the
official gazette on 07.10.2000, with the prior approval of the
Central Government; these regulations were amended whereby the
procedure for admission in post graduate courses has been
prescribed in detail; these regulations provide that admission, in
post graduate medical courses, must be on the basis of merit, and
merit alone; the mandatory and binding character of the statutory
regulations have been upheld by Courts; the Courts would not,
normally, interfere with the qualifications prescribed by expert
bodies like the M.C.I, especially for admission into super-specialty
medical courses; the M.C.I was superseded by the Board of
Governors, nominated by the Central Government, in May, 2010;
the entire work of M.C.I was carried out thereafter by the Board of
Governors, who later demitted office in November, 2013; the Board
of Governors, nominated by the Central Government, constituted a
Speciality Board to re-examine the eligibility criteria for admission
into various super-specialty courses including D.M (Endocrinology)
as provided under the Post Graduate Medical Education
Regulations, 2000; the three members of the Speciality Board, who
are eminent specialists in the field of medicine and in the
concerned super-specialty of Endocrinology, were (i) DR. Nalini
Sameer Shah, Professor & Head of the Department of
Endocrinology, Seth G.S. Medical College, K.E.M. Hospital, Parel,
Mumbai; (ii) Dr. Krishna G. Sheshadri, Professor and Head of
Endocrinology and Diabetes at Sri Ramachandra University,
Chennai and (iii) Dr. Nikhil Tandon, Professor & Head of the
Department of Endocrinology, AIIMS, New Delhi; the members of
the Specialty Board, after detailed discussion and due
deliberations with regards the eligibility criteria for admission into
the D.M. (Endocrinology) super specialty course, unanimously
agreed that prior experience as a clinician is required for pursuing
the D.M (Endocrinology) course which is a clinical discipline; the
recommendations of the specialty board was placed before the
Board of Governors, nominated by the Central Government, in
their meeting held on 11.06.2012; after due deliberations, with
regards the eligibility criteria for admission into D.M.
(Endocrinology) course, the Board of Governors agreed with the
recommendations of the Specialty Board; a draft notification was
sent to the Central Government on 29.06.2012 for its approval;
after scrutinizing the proposed amendment in the Schedule to the
Post Graduate Medical Education Regulations, 2000, the Central
Government duly approved the same; thereafter the notification
was sent for publication in the gazette; the M.C.I. has amended the
regulations with the prior approval of the Central Government; the
amendment to the regulations dated 17.04.2013 was notified in
the gazette on 15.05.2013; after the amendment, all candidates
desirous of admission in the super-specialty D.M (Endocrinology)
course must have obtained a post-graduate degree, from a
recognized medical college, either in Medicine or in Pediatrics;
candidates possessing the post-graduate medical qualification in
Biochemistry are eligible for admission into other super-specialty
medical course such as D.M (Clinical Hematology), D.M.
(Immunology) and D.M. (Medical Genetics); the petitioners
contention that, after the amendment dated 17.04.2013, they
cannot pursue a super specialty course is misconceived; the
amendment dated 17.04.2013 is not unreasonable, discriminatory
or in violation of Article 14 of the Constitution of India; with a view
to discharge its statutory responsibilities under the Act, the M.C.I.
has, from time to time, framed and amended various regulations
with the prior approval of the Central Government for laying the
minimum norms and requirements; and the petitioners are not
entitled to the relief sought for.
Sri A. Sanjeev Kumar, Learned Counsel for the petitioner,
would submit that, ever since the Regulations were made in the
year 2000 till the year 2013 when the amended Regulations came
into force, M.D. (Biochemistry) was among the prescribed
educational qualifications for admission into the DM
(Endocrinology) super speciality course; the MCI has not assigned
any reasons for deleting M.D. (Biochemistry) from the prescribed
eligibility criteria for admission into D.M. (Endocrinology); the
deletion of M.D. (Biochemistry) is discriminatory, and in violation
of Article 14 of the Constitution of India; the report of the Specialty
Board does not disclose any valid reasons for deletion of the M.D.
(Biochemistry) course; the averment in the counter-affidavit that
students undergoing a post graduate course in Biochemistry are
not exposed to clinical subjects is erroneous; a perusal of the
syllabus, enclosed along with the Writ Petition, shows that
students undergoing M.D. (Biochemistry) course are exposed to
clinical subjects also; students who possess M.D. (Biochemistry)
qualification are similarly situated to those who have completed a
postgraduate degree course in Medicine or Pediatrics; students
who possess postgraduate qualification in these three courses are
similarly situated; retention of M.D. (medicine) and M.D.
(Pediatrics), while deleting M.D. (Biochemistry), as the eligible
qualification for admission into D.M. (Endocrinology) does not
satisfy the test of a valid classification; and it is arbitrary,
discriminatory and illegal. Learned Counsel would rely on Bidi
Supply Co. v. Union of India in this regard.
The Postgraduate Medical Education Regulations, 2000 were
made by the Medical Council of India in the exercise of its powers
under Section 33 of the Indian Medical Council Act, 1956. In the
Schedule thereto, the eligibility criteria stipulated for admission in
D.M. (Endocrinology) course was that the candidate must possess
a recognised degree (or its recognised equivalent degree) in M.D.
(medicine), M.D. (Pediatrics), and M.D. (Biochemistry). The
Regulations were amended by the Postgraduate Educational
Amendment Regulation 2012 and, in the schedule to the
Postgraduate Medical Education Regulations, 2000 under the head
D.M (doctor of medicine) for endocrinology at serial No.4, M.D.
(Biochemistry) was deleted. Consequent thereto, it is only
students, who possess a Post-graduate degree in Medicine or
Pediatrics, who are eligible to seek admission into D.M
(Endocrinology) super specialty course. The aforesaid amendment
to the Regulations were made, with the approval of the Central
Government, on 17.04.2013 and were published in the Gazette of
India dated 15.05.2013. For admission into the D.M
(Endocrinology) course, after the amendment was published in the
gazette on 15.05.2013, candidates, who possess a postgraduate
degree in Biochemistry, are no longer eligible.
The MCI has been set up as an expert body, under the
Indian Medical Council Act, 1956, to control the minimum
standards of medical education and to regulate their observance.
The Act empowers the MCI to prescribe the minimum standards of
postgraduate medical education; and it has implicit power to
supervise the qualifications or eligibility standards for admission to
medical institutions. The universities are guided by the standards
prescribed by the Medical Council. The Medical Council
Regulations have statutory force and are mandatory. (Dr.Preeti
Srivastava v. State of M.P. ; Harish Verma v. Ajay Srivastava ;
State of Kerala v. T.P. Roshana ). The validity of these statutory
regulations can only be impeached on the ground that it falls foul
of the parent Act or it is in violation of the constitutional
provisions, more particularly Part III of the Constitution of India. It
is not even the case of the petitioners that the amended Regulation
is in violation of the provisions of the Act. The challenge thereto is
limited to its being discriminatory and ultravires Article 14 of the
Constitution of India.
It must be presumed that the Legislature understands and
correctly appreciates the need of its own people, that its laws are
directed to problems made manifest by experience and that its
discriminations are based on adequate grounds. There is always a
presumption in favour of the constitutionality of an enactment,
and the burden is upon him who attacks it to show that there has
been a clear transgression of the constitutional principles. (Ram
Krishna Dalmia v. Justice S.R. Tendolkar ; Gauri Shanker v.
Union of India ). There is always a presumption in favour of the
constitutionality of an enactment/rule/regulation and the burden
is upon him who attacks it to show that there has been a clear
transgression of the constitutional principles. A rule cannot be
struck down as discriminatory on any a priori reasoning. Where a
party seeks to impeach the validity of a rule made by a competent
authority on the ground that the Rules offend Article 14, the
burden is on him to plead and prove the infirmity. The burden is
on the petitioner to set out facts necessary to sustain the plea of
discrimination and to adduce cogent and convincing evidence to
prove those facts for there is a presumption that every factor
which is relevant or material has been taken into account in
formulating the classification. Unless the classification is unjust
on the face of it, the onus lies upon the party attacking the
classification to show, by pleading and placing the necessary
material before the Court, that the said classification is
unreasonable and violative of Article 14 of the Constitution.(State
of J & K v. Triloki Nath Khosa ; G.D. Kelkar v. Chief Controller
of Imports and Exports ). It is no part of the respondents burden
to justify the classification or to establish its constitutionality.
(Triloki Nath Khosa7).
In order to establish that the protection of the equal
opportunity clause has been denied to them, it is not enough for
the petitioners to say that they have been treated differently from
others, not even enough that a differential treatment has been
accorded to them in comparison with others similarly
circumstanced. Discrimination is the essence of classification and
does violence to the constitutional guarantee of equality only if it
rests on an unreasonable basis. It is, therefore, incumbent on the
petitioners to show that the classification of students into those
who hold a postgraduate medical degree either in Medicine or
Pediatrics, and those who hold a postgraduate medical degree in
Biochemistry, is unreasonable and bears no rational nexus with its
purported object. (Triloki Nath Khosa7). The submission, urged
on behalf of the petitioners in this regard, is only that the MCI had
erred in holding that post graduates in Biochemistry, unlike post
graduates in Medicine and Pediatrics, do not have clinical
experience.
In examining this contention, it must be borne in mind that
Article 14 forbids discrimination, and its gravamen is equality of
treatment. A person setting up a grievance of denial of equal
treatment by the law must establish that, between persons
similarly circumstanced, some were treated to their prejudice and
the differential treatment has no reasonable relation to the object
sought to be achieved by the law. (Gauri Shanker6; Western U.P.
Electric Power & Supply Co. Ltd. v. State of U.P. ). While
Article 14 forbids class legislation, it does not forbid reasonable
classification for the purposes of legislation. In order, however, to
pass the test of permissible classification two conditions must be
fulfilled, namely, (i) that the classification must be founded on an
intelligible differentia which distinguishes persons or things that
are grouped together from others left out of the group, and (ii) that
the differentia must have a rational relation to the object sought to
be achieved by the statute in question. The classification may be
founded on different basis. What is necessary is that there must
be a nexus between the basis of classification and the object of the
Act/Regulation under consideration. (Gauri Shanker6; Ram
Krishna Dalmia5; Budhan Choudhry v. State of Bihar ). The
classification must rest upon a real and substantial distinction
bearing a reasonable and just relation to the thing in respect to
which the classification is made; and classification made without
any reasonable basis should be regarded as invalid. (Bidi Supply
Co.1; State of West Bengal v. Anwar Ali Sarkar ).
The complaint, of violation of Article 14 of the Constitution,
cannot be judged by adopting a doctrinaire approach. It is not
prudent or pragmatic to insist on a mathematically accurate
classification covering diverse situations and all possible
contingencies in view of the inherent complexities involved. (State
of Karnataka v. Mangalore University Non-Teaching Employees
Association ). The legislature enjoys considerable latitude, and
exercises its power of classification enriched by its experience and
taking into consideration myriad circumstances. (Ombalika Das
v. Hulisa Shaw ). Precision and arithmetical accuracy will not
exist in any categorisation, and such precision and accuracy is not
what Article 14 contemplates. As long as the broad features of the
categorisation are identifiable and distinguishable, and the
categorisation is reasonably connected with the object targeted,
Article 14 does not forbid such a course of action. (Subramanian
Swamy v. Raju ; Murthy Match Works v. CCE ; Roop Chand
Adlakha v. DDA ; Kartar Singh v. State of Punjab ; Basheer v.
State of Kerala ; B. Manmad Reddy v. Chandra Prakash
Reddy and Transport and Dock Workers Union v. Mumbai
Port Trust ).
The object sought to be achieved by the classification, in the
amended Regulations, is to further excellence in higher Medical
Education. The basis of classification of students, between those
who have a post graudate degree in medicine and pediatrics on the
one hand, and those having a post graduate degree in
Biochemistry on the other, for admission in D.M. (Endocrinology) is
their clinical experience. While the former group are said to have
the requisite clinical experience, the latter are said not to. As the
classification of post-graduate Medical students, between those
who have the required clinical experience and those who do not,
has a reasonable nexus to the object sought to be achieved i.e.,
maintenance of high standards of Medical Education by restricting
admission to DM (Endocrinology) course only to those students
who have the required clinical exposure, the test of a valid
classification is satisfied, and the petitioners plea of discrimination
must fail.
The contention, that no reasons are assigned for amending
the regulations, is also devoid of merit. Delegated legislation
cannot be questioned on the ground of violation of the principles of
natural justice, especially in the absence of any such statutory
requirement. Neither the Legislature nor its delegate are legally
obliged to give any reasons for their action while discharging their
legislative function. (K.T. Plantation Pvt. Ltd. v. State of
Karnataka ; State of Punjab v. Tehal Singh ; W.B. Electricity
Regulatory Commission v. CESC Ltd. ; Pune Municipal Corpn.
v. Promoters and Builders Assn. and Bihar SEB v. Pulak
Enterprises ). The basis of the classification of persons or things
may appear on the face of the statute or may be gathered from the
surrounding circumstances known to or brought to the notice of
the Court. (Ram Krishna Dalmia5; Gauri Shanker6).
Relevant material is always admissible to show the reason
and the justification for the classification. Such reasons need not
appear on the face of the Rule or the law which effects the
classification. (T.N. Khosa7). The reasons, which necessitated
amendment of the Regulations, are detailed in the counter-affidavit
filed on behalf of MCI, and are evident from the record placed for
our perusal, which include the report of the speciality board
consisting of three eminent Endocrinologists in the country. In the
absence of any such requirement, either in the parent Act or in the
Regulations themselves, the reasons which necessitated
amendment of the Regulations need not be reflected in the
Regulations itself and can be gathered from the surrounding
circumstances or, for that matter, can be stated in the counter-
affidavit filed before this Court.
The mere fact that M.D. (Biochemistry) was among the
prescribed qualifications for admission into D.M. (Endocrinology)
for thirteen years, from when the Regulations were made in the
year 2000 till they were amended in the year 2013, is of no avail.
The eligibility criteria for admissions in super-speciality medical
courses must be periodically reviewed by the MCI keeping in mind
the need to maintain excellence and high standards in higher
medical education. Determination of such standards is part of the
academic policy of the MCI. (Visveswaraiah Technological
University v. Krishnendu Halder ). Revision of standards, for
admission into super-speciality courses in Medicine, are matters of
policy. The Court cannot strike down a policy merely because
there is a variation. Consistency is not always a virtue. What is
important is to know whether irrational and extraneous factor foul.
(Tamil Nadu Education Deptt. Ministerial & General
Subordinate Services Assn. v. State of T.N. ). There can be no
quarrel if a policy is revised. The wisdom of yesterday may
obsolesce into the folly of today, even as the science of old may
sour into the superstition now, and vice versa. (Tamil Nadu
Education Deptt. Ministerial & General Subordinate Services
Assn.27). Reform must begin somewhere if it has to begin at all
and, therefore, the administrator who has complex problems to
solve must be allowed the freedom to proceed tentatively, step by
step. (T.N. Khosa7). The petitioners cannot be heard to contend
that qualifications, once prescribed, must continue forever and not
be subjected to change at all.
The records placed before this Court by Sri D. Srinivas,
Learned Standing Counsel for MCI, reveal that a Board of Experts
was constituted to examine the course content for D.M.
(Endocrinology). In its report submitted to the Board of Governors
of MCI, the expert committee opined that the goals of the D.M
programme, in Endocrinology, Diabetes and Metabolism, was to
provide comprehensive knowledge, clinical skills, professional
attributes and values to prepare trainees to care for patients
suffering from diseases of the endocrine system; to ensure clinical
care experience to a variety of patients suffering from diverse
endocrine problems, and in diagnosing and managing such
patients; and to provide a diverse learning experience to trainees in
allied areas as they relate to endocrinology, diabetes and
metabolism. The expert body suggested that the name of the
course be renamed as Doctor of Medicine (D.M) in Endocrinology,
Diabetes and Metabolism and the eligibility therefor be prescribed
as a post-graduate degree in M.D (Internal Medicine) or M.D
(Pediatrics) in three years.
While recommending the competence standards for
undergoing the DM (Endocrinology) course, the Board of experts
opined that the postgraduate must demonstrate competence in
clinical care including evaluation and management of horomonal
problems, acute life threatening complications of hyper and hypo
glycemia; metabolism in adults and children, and other aspects of
Endocrinology and Metabolism. The emphasis placed by the
expert body was on competence in clinical care in various
areas/aspects. As the expert body was of the view that such
clinical exposure is given only to those students who undergo a
post-graduate degree course in internal Medicine or in Pediatrics,
the eligibility criteria for admission into D.M (Endocrinology) was
restricted only to these courses. On receipt of the
recommendations of the expert body the M.C.I, after complying
with the requirements of Section 33 of the Act, deleted M.D
(Biochemistry) from among the educational qualifications
prescribed as the eligibility criteria for admission into the D.M
(Endocrinology) super specialty course.
The contention that Medical post-graduates in Biochemistry
have the required clinical exposure cannot be examined in writ
proceedings under Article 226 of the Constitution of India. The
Court lacks the expertise to examine academic policies and would,
ordinarily, abide by the opinion of experts. Courts should be slow
to interfere with the opinions expressed by experts, and must leave
such decisions to those who are more familiar with such problems,
than the Courts generally can be. (State of T.N. v. K. Shyam
Sunder ; University of Mysore v. C.D. Govinda Rao ; Neelima
Misra v. Harinder Kaur Paintal ; Victoria Memorial Hall v.
Howrah Ganatantrik Nagrik Samity ; Basavaiah (Dr.) v. Dr.
H.L. Ramesh and State of H.P. v. H.P. Nizi Vyavsayik
Prishikshan Kendra Sangh ). Whether or not students who have
undergone M.D. (Biochemistry) course have been given clinical
exposure on par with those who have undergone M.D. (Medicine)
or M.D (Pediatrics) courses, are matters of expertise which this
Court lacks, and are technical questions not, ordinarily, amenable
to judicial review.
The Court would not substitute its opinion for that of the
Legislature or its delegate as to what policy would best serve the
objects and purposes of the Act or sit in judgment over the wisdom
and effectiveness or otherwise of the policy laid down by the
regulation-making body, and declare a regulation to be ultravires
merely on the ground that, in the view of the Court, the impugned
provisions will not help to serve the object. As long as the body,
entrusted with the task of framing the rules or regulations, acts
within the scope of the authority conferred on it, in the sense that
the rules or regulations made by it have a rational nexus with the
object, the court would not concern itself with the wisdom or
efficaciousness of such rules or regulations. It is exclusively within
the province of the Legislature and its delegate to determine, as a
matter of policy, what measures would have to be incorporated in
the rules or regulations for the efficacious achievement of the
objects.
It is not for the Court to examine the merits or demerits of a
policy. (Maharashtra State Board of Secondary and Higher
Secondary Education v. Paritosh Bhupeshkumar Sheth ). It
may be a wise policy which will effectuate the purpose of its
enactment or it may lack effectiveness calling for its revision and
improvement. Any drawbacks in the policy, incorporated in a rule
or regulation, will not render it ultra vires and the Court would not
strike it down on the ground that, in its opinion, it is not a wise or
prudent policy. The Legislature and its delegate are the sole
repositories of the power to decide what policy should be pursued
in relation to matters covered by the Act. (Maharashtra State
Board of Secondary and Higher Secondary Education34).
Equivalence of educational qualifications is a technical
question based on a proper assessment and evaluation of the
relevant academic standards and practical attainments of such
qualifications, and where the decision is based on the
recommendation of an expert body which possesses the requisite
knowledge, skill and expertise for adequately discharging such
functions, the Court, uninformed of relevant data and unaided by
the technical insights necessary for the purpose of determining
equivalence, would not lightly disturb the decision. It is only where
the decision is shown to be based on extraneous or irrelevant
considerations or is actuated by malafides or is irrational and
perverse or is manifestly wrong that the Court would reach out its
lethal arm and strike down the decision. (Mohd. Shujat Ali v.
Union of India ). The Court would not sit in appeal over the
legislative judgment to find out whether, on a comparative
evaluation of the rival theories touching upon the question of
equivalence in educational qualifications, the theory advocated by
the petitioners is not to be preferred. Classification is primarily for
the legislature or for the statutory authority charged with the duty
of framing the eligibility criteria and if, looked at from the
standpoint of the authority making it, the classification is found to
rest on a reasonable basis, it has to be upheld. (Triloki Nath
Khosa7). This Court would defer to the wisdom of the Speciality
Board whose members are experts in the field of Endocrinology,
more so as no malafides are attributed to them, and their expertise
in this regard is not in doubt.
The contention that deletion of M.D. (Biochemistry), from the
list of eligible educational qualifications required for admission into
D.M (Endocrinology) course, would deny the petitioners the
opportunity of undergoing any super speciality course, does not
also merit acceptance. It is evident, from the counter-affidavit filed
on behalf of the MCI, that M.D (Biochemistry) is among the
prescribed educational qualifications for admission into the super
speciality courses of D.M (clinical Hematology), DM (Immunology)
and D.M (Medical genetics). The M.C.I. lays down uniform
standards for medical education applicable to all the universities
throughout the country and the petitioners, some of whom are
undergoing their post graduation in Biochemistry in the States of
Telangana and Andhra Pradesh, cannot claim to stand on a
different footing. While the amendment to the Regulations has
resulted in their being denied the opportunity of undergoing the
D.M (Endocrinology) course, that, by itself, would not justify
striking down the statutory regulations, which are otherwise valid.
Viewed from any angle, the petitioners are not entitled to the
relief sought for. The Writ Petition fails and is, accordingly,
dismissed. The miscellaneous petitions pending, if any, shall also
stand dismissed. No costs.
_____________________________
RAMESH RANGANATHAN, J
___________________________________
M. SATYANARAYANA MURTHY, J
Date: 31-12-2014.
