The Parliament’s decision to send the draft National Medical Commission Bill, 2017, to the standing committee of health has raised hopes for a constructive debate among political parties to remove the draconian clauses in the proposed bill. If not modified, the bill will replace the Medical Council of India (MCI) by a near-total central government department called the National Medical Commission (NMC). Devoid of a federal character, this non-representative body will be a poor substitute for the MCI.
The proposed NMC is not representative of the medical profession in India. The MCI has one representative each from state and practising doctors. With this being taken away, it remains to be seen how the ethics of practising doctors providing care to 80 percent of the population can be managed without having representatives from their own tribe.
The Indian Medical Association (IMA) is the collective consciousness of more than three lakh doctors from modern medicine, yet it was not consulted when the Union Cabinet took this decision to replace the MCI with the NMC.
The bill is not ‘national’ as it does not represent all states. Although, each state government does have the presence of a vice-chancellor in the body, the official will be appointed by the governor in through the Center. It isn’t ‘medical’ either as it allows the mixing of ‘Ayush’ with ‘modern medicine. Combining the two in the same treatment by the same doctor will constitute a new treatment and hence necessitate a trial, which would require the approval of the ethics committee.
The NMC is not a ‘commission’ as any commission requires the provision for a developmental grant in the five-year plan. It’s also not ‘representative’ as there is no representation of doctors from every state but only five elected zonal members in the commission with only an appellant authority. The so-called four ‘autonomous’ boards, with full powers, will have 12 nominated salaried full-time members with no representation from elected members. The bill is not ‘community-friendly’; the bill will make medical education expensive in the future. This is because the bill will increase the percentage of fee to be decided by the private colleges from 15 percent to more than 60 percent of seats.
One of the main contentions for replacing the bill was to get a new corruption-free mechanism but the NMC has the potential to breed corruption. Full powers are given only to three full-time nominated members in the board appointed on salary by the government. The commission has only appellant powers; more than 60 percent medical seats in private colleges will have no fee restriction and the penalty for violating norms will vary from 1/2 to 10 times (for example, from 5 crore to 100 crore). Also, the central government vests total control on waiving off penalty, giving permissions, and allowing doctors to practice without fulfilling all norms. The bill is also not ‘students’ friendly’. Those medical students who pass MBBS by grace but fail in the licentiate exam will not be allowed to practice. The ‘so-called’ autonomous boards are not really autonomous as all boards are under direct control of the government and the commission. And, the commission has regulatory as well as directional powers. The secretary of the commission can be a non-doctor appointed by the government.
The bill is not IMA-friendly, which was not made a part of discussions despite being the largest stakeholder comprising government and private doctors, students, teachers, and hospitals. It is not ‘state medical council-friendly’ either as it takes away their autonomy to function. Not only this, the NMC will even have directional power over state governments. I hope the standing committee on health will rectify these anomalies by either amending the present NMC act or bring in a better act that takes into account IMA’s concerns.
KK Aggarwal is vice president, Confederation of Medical Associations in Asia and Oceania and former National President IMA - The Hindustan Times