Sunday, November 10, 2013

Editorial

Re-Constitution & Composition of Democratically
Elected Autonomous MCI

Quality of Medical Education & Healthcare depends on Quality of Decisions, which only Quality persons (Doctors, Medical Teachers) can take. Entry of Quality persons in composition and constitution of Apex Medical Education Regulatory Body i.e. MCI is possible only through participatory and democratically elected process in unbiased, uninfluenced, fair and transparent manner. Competent and experienced members, who are of high moral value and integrity is the need of the hour. Autonomy of professional’s body can only be possible through its members who are acting with their wisdom without any influence of whatever nature. It is expected that elected members are able to take decisions in unbiased manner, keeping in mind the prime objective of quality of medical education and quality healthcare and above all the service of humanity.
Background of the Issue:
The Indian Medical Council Rules, 1957, Published in Part II- Section 3 of the Gazette of India, No.F.5-2/57-MI.Government of India Ministry of Health, New Delhi, Dated: the 16th April, 1957. The Central Government had made these rules, in exercise of the powers conferred by section 4 and 32 of the Indian Medical Council Act, 1956 (102 of 1956). Subsequently in the year 1980 and 1992 certain Amendments have been done to smooth conduct of elections and clarification of certain provisions related to constitution and composition of Medical Council of India. Amendments in 1980 were especially done to clarify the election of one member from the University having medical faculty.
Role of Central Government:
The Indian Medical Council Act, 1956 and the Rules of 1957 were made keeping in mind the responsibility given under Constitution of India, as the matter of medical education was falling in the Concurrent List. It is the responsibility of the Central Government to make effort and coordinate activities to remove difficulties in enforcement of provisions of the Indian Medical Council Act, for which it can make Rules and MCI can make Regulations with previous permission of Central Govt.
It is the responsibility of the Central Government to publish the name of elected medical faculty member, intimated by the Registrar of the University for Publication in the Official Gazette by Notification, after which it becomes public document. Recently published Gazette Notification for reconstitution of MCI on 5th November 2013 contains 68 members from elected and nominated category.
Appointment of Returning Officer for Election of President of MCI:
Appointment of ‘Returning Officer’ for the purpose of these rules and conduct of elections means any officer appointed as such by the Central Government for the purposes of these rules; this provision clarifies that it is the responsibility of the Central Govt. to hold/conduct elections for the Members of MCI in unbiased, uninfluenced and in fair and transparent manner. [Section 2(d)] Role of central Government has been further made clear by the para 25 of the Rules, 1957, which reads:
“Power to declare any election void: The Central Government may, on objection made by a candidate for any election within a period of thirty days from the date of the election of the candidate, or of its own motive at any time, declare the election to be void on account of bribery, undue influence or other corrupt practice which, in the opinion of the Central Government, has interfered with the free and fair conduct of the election or for any other sufficient cause, and may call on the electorate to make a fresh election.” [Section 25(1)]
Sub-para (2) of the para 25 talks about the finality of decision of Central Government which reads as: “The decision of the Central Government under this rule shall be final.” [Section 25(2)]
I am receiving many mails and phone calls on the conditions of confidentiality exposing irregularities and illegalities done in the conduct of elections (for reconstitution of MCI IN 2013) at University levels in the form of many bias, undue influences and unfair conduct of elections which are not transparent. Even specific provision made for 30 days time between intimation of notification for nomination and election and day on which actual election will be held.
There is no clarity whether a non-medical faculty working in a medical college (with M.Sc. qualification) will be allowed to vote or file nomination for election. Situation with regard to Private Universities is worst, as evident that their names were missing from the previous letter dated 14.06.2013 and Government on 27.08.2013 has issued separate notification for clarifying and declaring election conducted by the ‘Deemed Universities as ‘Null and Void’.
Indian Medical Register:
For any election in democratic organization eligibility of electoral and awareness of their right to exercise vote is mandatory requirement. To avoid ineligible candidate to contest elections or to be nominated, updated “Indian Medical Register” at the National Level and “State Medical Register” in each State having State Medical Council should be the first step in this direction.
It is the responsibility of the State Government to regulate the practice of medicine and have disciplinary control over the doctors registered with the State Medical Council and take timely action in the welfare of its subjects availing healthcare services. Mandatory Registration with the State Medical Council for contesting election through State Medical Council and University having medical faculty or nominated with consultation with State Government in that particular State.
Need for Code of Conduct:
In Delhi Medical Council election use of SMS or email or social media networking using indecent language and behaviour should be checked at all cost to maintain the nobility of the Profession. This indecent behaviour may amount to professional misconduct and unethical behaviour on the part of contestant and action may be initiated by the concerned State Medical Council or Medical Council of India on the written complaint with evidence, as the case may be. Even rules made by the MCI for student’s election have detailed provisions for code of conduct than for election of MCI Members.
Role of Registrar:
Registrar of the University has duty to intimate name of elected person to the Central Government after conduct of election. Who actually vote to elect medical faculty whether ‘members of the Senate’ or ‘members of the Court’, as there was confusion on this point that only ‘members of Senate / the Court’ will use right to vote to elect a member of the medical faculty.
In many cases both contestant (medical faculty member) and members of the Senate/the Court do not know each other. In private universities where there is no transparency in the constitution of the Senate/the Court or not constituted and if constituted not revised as per the prescribed manner and no meeting held for years together. This is not a general election but to elect a body of professional experts who are going to decide the fate of medical education and healthcare of whole India.
Role of Members of the Senate of the University/Members of the Court /Vice-Chancellor of the University:
The members of the Senate of the University or in case the University has no Senate, the members of the Court shall elect a member in such manner as the Vice-Chancellor of the University may think fit. [Sec 4] this is the most controversial and wrongly worded clause or wrongly interpreted in holding the election or misusing for vested interests. This clause needs to be clarified to make election process uniformly throughout India. I have used Right to Inform to clarify this clause from the Ministry of Health and Family Welfare, Government of India through online RTI portal (www.rtionline.gov.in) on 23.10.2013. Response is awaited and hopefully we get answer if everything goes right within 30 days of my application.
Types of Universities:
1.     Govt. University:  A. Central Govt. University   B. State Universities
2.     Private University
3.     Deemed to be University
4.     Purely Medical University/Health Sciences University (e.g. Haryana, Punjab, Karnataka, Kerala, Maharashtra, etc.)
5.     General University with Medical College as one of the either affiliated college or constituent medical college?
Depending on the type of university composition and constitution of members of the Senate /the Court will change, with reference to whether they are medical faculty or non-medical persons. A university with many constituent /affiliated colleges other than medical college will have predominately non medical faculty as members of the Senate /the Court. How these non-medical members will be able to elect a member for expert body who has competence and knowledge about medical education and its complex requirements.  It is important in view of large Private Universities coming up with Private Medical Colleges and many of them are general university and not health universities only (whose majority members are medical persons). Purpose of Election for Membership of MCI u/s 3(1) (b) should be election of medical faculty to be elected by medical faculty in the better interest of Quality of medical education and healthcare.
Need for Redrafting and Amendment in the Rules for Election:
Need for true participatory nature of the MCI especially under section 3(1) (b): to be elected by the Medical Faculty not by Members of the Senate or Court of the University (If they are non-medical persons, Registration in State Medical Council should be mandatory).
True meaning of Democracy means Government of the People (Doctors and Medical Faculty in case of MCI, an Autonomous Body), for the People (Doctors and Medical Faculty, their interests are at stake) by the People (by Doctors or Medical Faculty, because it is a specialist based professional organization need to discuss and take decisions on complex issues for the welfare of the people of India).      
There is need for redrafting of rules in changed circumstances. Law is dynamic and it changes with time and demands of the society for the welfare and protection of society. There is need to understand that what was the purpose of provision for different category of members of MCI i.e. elected members and nominated members. Following questions need detailed deliberations:
·         Whether nominated members by the Central Govt. (Category) or Nominated in consultation with State Government can be Non-Medical Person?
·         What are the criteria for their nomination in terms of manner of nomination and in terms of Qualification and Experience?
·         Who (which authority of the Central Govt.) will initiate the process of nomination and in what manner so that it will be in the better interest of Quality of Medical Education, the object for which the Indian Medical Council Act, 1956 has been enacted?
There is need for transparency and fairness in every process whether election or nomination of member is concerned. If election it should be unbiased and uninfluenced, especially in cases of Private Medical Colleges and Private Universities.
There is need to see whether any “Conflict of Interest” is involved or not in terms of election /nomination process or members so elected /nominated in decision making by the MCI during permission given for UG /PG Courses. On the other hand checks and balances needed to avoid any situation of misuse of power against any private management of medical colleges or Private universities.
Why there was need for Elected Members from State Medical Council?
This provision was made probably for following reasons:
·         To give representation to hear their voice in cases unnecessary harassment whenever there is a complaint of unethical practices or medical negligence cases.
·         To give representation to the private practitioners.
What was the purpose of Nominated members in consultation with State Govt.?
·         To give equal representation and making MCI representative body for different States of the India
·         To make regional balance and make it truly representative in character.
Fairness of Elections and Transparency in Holding Elections:
Do anybody can think that Registrar of Private University (Returning Officer under section 4a) has power to conduct unfair, unbiased and uninfluenced elections where persons/voters (Chancellor, Pro-Chancellor, Vice-Chancellor, Pro-Vice-chancellor, and members nominated by the Chancellor, all are above in hierarchy to Registrar as per the Organogram of the University) exercising vote against /or favour of any faculty members and we will still call these elections as unfair, unbiased and uninfluenced elections, where everything happening at the mercy of the private management without following principles of natural justice.
Is this not mockery of the democratic process of elections in reconstitution of the Medical Council of India? There is urgent need to think on these issues and rules for election of MCI Members should be redrafted keeping in the mind current scenario and circumstances prevailing after privatization of medical education in India, otherwise result will be disastrous in long run with irreparable losses to Quality of Medical Education and Quality of Healthcare.
In Gazette notification dated 5th November 2013 many Vice-Chancellors have been shown as elected members; even Chairman of Private Medical Colleges has been made elected members in complete violation of “Conflict of Interests” and university rules. Let see the consequences in future of this undemocratically elected so called Autonomous MCI, entrusted with Quality of Medical Education in India. 

Dr.Mukesh Yadav
Editor, JIAFM
J Indian Acad Forensic Med. October-December 2013, Vol. 35, No. 4: 302-304 (ISSN 0971-0973)

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