Monday, July 2, 2018

Medical Council of India V.s Vedantaa Institute of Academic Excellence Pvt. Ltd. -JUNE 01, 2018

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Reportable
IN THE SUPREME COURT OF INDIA
CIVIL APPELLATE JURISDICTION
Civil Appeal No.5805 of 2018
(Arising out of S.L.P. (Civil) No.11164 of 2018)

Medical Council of India .... Appellant
Versus
Vedantaa Institute of Academic Excellence Pvt. Ltd. and Ors. ….Respondents

J U D G M E N T

L. NAGESWARA RAO, J.
Leave granted.
1. Vedantaa Institute of Academic Excellence Pvt. Ltd. and
Vedantaa Institute of Medical Sciences, Respondent Nos.1 and 2
herein filed Writ Petition No.4319 of 2018 in the High Court of
Judicature at Bombay seeking a direction to the Appellant to send
its Experts’ team for the purpose of verifying the compliance of
the deficiencies pointed out earlier. They also prayed for a
direction to the Appellant to forward its recommendation to the
Central Government before 30th April, 2018. They sought a
further direction to Respondent No.3 herein, Union of India to
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consider the grant of renewal permission on the basis of the
recommendations received from the Appellant. The High Court
allowed the Writ Petition and directed the Medical Council of
India to inspect Respondent No.2, Medical College and submit a
report to the Union of India before 30th April, 2018. Aggrieved
thereby, the Appellant Council has filed the above appeal.
2. Respondent No.1 submitted an application under Section
10-A of the Indian Medical Council Act, 1956 (hereinafter
referred to as the ‘Act’) for starting a Medical College. A letter of
intent was issued to Respondent No.1 after conducting an
inspection. The Union of India issued a letter of permission dated
31.05.2017 to Respondent No.1 to admit the first batch of 150
students for the academic year 2017-2018. After issuance of a
letter of permission, the Respondent No.2 College was included
in the list of Colleges for centralised process of admission carried
out by the State of Maharashtra. Students were allotted for the
year 2017-2018 in the centralised counselling. The inspection for
the purpose of granting first renewal for admission of students for
the academic year 2018-2019 was conducted on 25.09.2017 and
26.09.2017. The Executive Committee of the Appellant Council
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considered the assessment report in its meeting held on
25.10.2017 and it was decided as under:-
“The Executive Committee of the Council considered the assessment
report (25/26.09.2017) and noted the following:-
1. Deficiency of faculty is 84.05% as detailed in the report.
2. Shortfall of Residents is 87.23% as detailed in the report.
3. Pathology, Microbiology, Pharmacology, Forensic
Medicine, Community Medicine departments are under
construction
4. Bed Occupancy is 01% at 10 a.m. on day of assessment.
5. Wards: Majority of the wards were locked or under
renovation and non-functional.
6. Data of OPD attendance, Radiological & laboratory
investigations are inflated.
7. There was NIL Major, NIL Minor & NIL Daycare Operation
on day of assessment.
8. There was NIL woman in Labour room.
9. Nursing staff: 164 Nursing staff are available against
requirement of 175.
10.Paramedical & Non-teaching staff: 90 Paramedical & Nonteaching
staff are available against requirement of 100.
11.MRD: There is no MRD Office.
12.O.T.: Non of O.T. was functional on day of assessment
13.ICU: There was NIL patient in ICCU & all ICUs on day of
assessment.
14.1 Mobile X-ray machine is available against requirement
of 2.
15.Blood Bank is not functional.
16.Kitchen is not functional.
17.Examination hall: It is under construction.
18.Central Library: Librarian is not available.
19.Central Photography section: There is no staff.
20.Students’ Hostels: Available accommodation is for 128
students against requirement of 226.
21.Residential quarters: 18 quarters are available for faculty
against requirement of 20. 16 quarters are available for
non-teaching staff against requirement of 32.
22.RHTC: It is not yet allotted.
23.UHC: It is not yet allotted.
24.There is no CME activity during the year.
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25.Other deficiencies as pointed out in the assessment
report.
The Executive Committee noted that Regulation 8(3)(1)(a) of
the Establishment of Medical College Regulation
(Amendment), 2010 (Part II), dated 16th April, 2010 and
amended on 18th March, 2016 provided as under:-
“8(3)(1)…..
(a) Colleges in the stage of Letter of Permission upto II renewal
(i.e. Admission of third batch)
It is observed during any inspection/assessment of the
institute that the deficiency of teaching faculty and/or
Residents is more than 30% and/or bed occupancy is <50 p="">(45% in North East, Hilly terrain etc.), compliance of
rectification of deficiencies from such an institute will not be
considered for issue of Letter of Permission (LOP)/ renewal
of permission in that Academic Year.”
In view of the deficiencies as noted above, the Executive
Committee of the Council decided to recommend to the
Central Govt. to invoke Regulation 8 (3)(1)(a) of the
Establishment of Medical College Regulation, 1999 and
disapprove the application of the Vedantaa Institute of
Medical Sciences, Palghar, Maharashtra under Maharashtra
University of Health Sciences Nashik u/s 10A of the IMC Act,
1956 for renewal of permission of MBBS course 2nd batch
(150 seats) for the academic year 2018-2019.”
3. The said decision of the Executive Committee was
approved by the Oversight Committee on 16.11.2017. The
Appellant by a letter dated 21.11.2017 communicated the
decision of the Executive Committee as approved by the
Oversight Committee to the Union of India. By a letter dated
07.12.2017, the Respondent No. 3, Union of India directed the
Respondent College to respond to the recommendation of the
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Appellant. A detailed reply was submitted by the College and
even a personal hearing was given.
4. The High Court allowed the Writ Petition filed by
Respondent No.1 and 2 mainly on two grounds. According to the
High Court, Regulation 8 (3) (1) proviso (a) of the Establishment
of Medical College Regulations, 1999 (hereinafter referred to as
the Regulations) is not applicable to the case of Respondent No.1
and 2. The relevant portion of Clause 8 (3) (1) is extracted as
under:-
“8 GRANT OF PERMISSION:
(3)(1). The permission to establish a medical College and
admit students may be granted initially for a period of
one year and may be renewed on yearly basis subject
to verification of the achievements of annual targets. It
shall be the responsibility of the person to apply to the
Medical Council of India for purpose of renewal six
months prior to the expiry of the initial permission. This
process of renewal of permission will continue till such
time the establishment of the medical College and
expansion of the hospital facilities are completed and a
formal recognition of the medical College is granted.
Further admissions shall not be made at any stage
unless the requirements of the Council are fulfilled. The
Central Government may at any stage convey the
deficiencies to the applicant and provide him an
opportunity and time to rectify the deficiencies.
Note: In above clause, “six months” shall be substituted
by “as per latest time schedule”
PROVIDED that in respect of a) Colleges in the stage
of Letter of Permission upto II renewal (i.e.
admission of third batch)
If it is observed during any inspection/assessment of the
institute that the deficiency of teaching faculty and/or
Residents is more than 30% and/or bed occupancy is
<50 compliance="" east="" etc.="" hilly="" in="" nbsp="" north="" p="" terrain="">6
of rectification of deficiencies from such an institute will
not be considered for issue of Letter of Permission
(LOP)/renewal of permission in that Academic Year.”
5. The other point which found favour with the High Court is
the manner in which the inspection was conducted. The High
Court held that the inspection conducted by the Assessors was
not fair.
6. Mr. Vikas Singh, learned Senior Counsel appearing for the
Appellant submitted that findings recorded by the High Court
that Regulation 8 (3) (1) is not applicable to the Respondent
College as it had sought for first renewal is clearly erroneous. He
submitted that the High Court lost sight of the first proviso to
Regulation 8 (3) (1). He contended that there is no ambiguity in
the language of the first proviso to Regulation 8 (3) (1) which
covers Colleges upto the second renewal. According to the said
Regulation, Institutions having deficiency of teaching faculty
and/or residents more than 30 per cent and/or bed occupancy
less than 50 per cent will not be considered for renewal of
permission for that academic year. In view of the large scale
deficiencies found in the inspection conducted on 25.09.2017 and
26.09.2017, Mr. Singh submits that there is no question of an
opportunity being given to Respondent No.1 to rectify the
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deficiencies. He also urged that the inspection was done strictly
in accordance with the Assessors’ Guide issued by the Medical
Council of India. He pointed out that the general instructions
issued to the Assessors clearly shows that it was mandatory to
verify the attendance sheet of every department (completed
before 11.00 am), signed by the faculty present on the day of
assessment and duly counter-signed by the Head of Department.
According to the Assessors’ Guide the institutions should be
asked to submit daily average clinical data for the last 12 months
and clinical data of the first day of assessment. Bed occupancy
was to be verified at 10.00 am, whereas OPD, Laboratory and
Radiological Investigation data etc. are to be verified at 2.00 pm
on the first day of assessment. In respect of verification of
teaching faculty and resident doctors, the Assessors’ Guide
provides for checking of faculty attendance before 11.00 am on
the first day of assessment. Only faculty/residents who signed the
attendance sheet before 11.00 am are to be verified. No
verification should be done for the faculty/residents coming after
11.00 am. Mr. Vikas Singh, learned Senior Counsel took us
through the inspection notes to submit that the inspection done
by the assessment team cannot be found fault with. He also
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relies upon the judgment of this Court in Medical Council of
India v. Kalinga Institute of Medical Sciences (KIMS) &
Ors.1
, to state that the report of the Experts should not be
interfered with by this Court.
7. Mr. Maninder Singh, learned Additional Solicitor General,
appearing for the Union of India submitted that the provisos to
Regulation 8 (3) (1) was inserted with a view to ensure that
Institutions which do not satisfy the minimum infrastructure and
faculty cannot to be given an opportunity to rectify their defects.
According to him, the standards fixed by the Medical Council of
India are the bare minimum and have to be strictly complied with
to ensure the maintenance of basic minimum standards of
medical education. Any lenience shown by this Court in
providing an opportunity to such Institutions to rectify the defects
will have a cascading effect in the succeeding years and would
result in Colleges continuing to function with deficiencies as well
as producing half baked and poor quality doctors. He showed
us the predictions made by the Meteorological Department from
20th September, 2017 to 26th September, 2017. He submitted that
thunderstorm and heavy rain is common in coastal areas and the

1 (2016) 11 SCC 530- Para 24
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situation was not as dangerous as projected by Respondent No.1
and 2. He further submitted that the minimum requirement of
faculty and residents is 70 per cent. He stated that if 70 per cent
of the strength of residence had to be present in the hospital on
24.09.2017 (i.e. the previous day of inspection), it is
inconceivable that there could be shortage of 84 per cent
teachers and 87 per cent of residents on the date of inspection.
He also stated that a natural calamity like cyclone would result in
increase in the number of patients.
8. Mr. Ranjit Kumar, learned Senior Counsel appearing for the
Respondent No.1 and 2 supported the judgment of the High
Court. He relied upon the judgment of this Court in Royal
Medical Trust (Registered) v. Union of India2
to support his
submission that an opportunity has to be given to a Medical
Institute to rectify the deficiencies. He countered the submission
of learned Senior Counsel for the Medical Council of India by
submitting that the Regulations cannot over-ride the statute.
According to him, Section 10-A as interpreted by this Court
entitles the Respondent College to be provided with an
opportunity to cure the defects pointed out during the inspection.

2 (2015) 10 SCC 19 paras 26 - 31
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Such provision cannot be over ridden by a Regulation. He relied
upon the prediction of cyclone whereby the people of the locality
were asked to stay indoors. He contended that a request was
made to the team of Assessors to have another assessment on the
same day. He further submitted that the inspection was not
conducted in a fair manner and the report does not represent the
correct picture. If another inspection is done by the Medical
Council of India to verify the facilities available in the hospital
and the College, the College would be able to satisfy the
requirements. He relied upon the decision taken by the Medical
Council of India in directing fresh inspection to be conducted in
respect of a few Colleges where the deficiencies were more than
the minimum prescribed in Regulation 8 (3) (1) (a). In reply to
the submissions of Mr. Ranjit Kumar on this point Mr. Vikas Singh
stated that a second inspection was permitted to be done only in
respect of Government Medical Colleges.
9. Though Regulation 8 (3) (1) (a) was challenged in the Writ
Petition filed by Respondent No.1 and 2, they did not press the
relief. They restricted their challenge to the manner in which the
inspection was done and for a direction to the Appellant-Council
to carry out a fresh inspection. The interpretation of Regulation 8
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(3) (1) (a) by the High Court is patently erroneous in as much as
the High Court did not take note of the proviso to Regulation
8(3)(1). Without a proper examination of the provision, the High
Court fell in error in holding that Regulation 8 (3) (1) (a) would be
applicable only to the Colleges seeking second renewal i.e.
admissions of the third batch. Admissions upto the second
renewal i.e. admissions to third batch would fall under Regulation
8 (3) (1) (a). In other words, the proviso is not restricted only to
second renewal cases. Even the first renewal is covered by
proviso (a) to Regulation 8 (3) (1) as the language used is “upto
second renewal”. We do not see any conflict between Section
10-A (3) and (4) of the Act on one hand and Regulation 8 (3) (1)
(a) on the other. Regulation 8 (3) (1) (a) is complementary to
Section 10-A of the Act. Fixing minimum standards which have to
be fulfilled for the purpose of enabling a medical College to seek
fresh inspection would not be contrary to the scheme of Section
10-A. In fact, Regulation 8 (3) (1) provides that an opportunity
shall be given to the medical College to rectify the defects. But,
the proviso contemplates that certain minimum standards are to
be satisfied i.e. there should not be deficiency of teaching faculty
and/or residents more than 30 per cent and/or bed occupancy
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should not be less than 50 per cent. This prescription of
standards for availing an opportunity to seek re-inspection is
not ultra vires either the Regulation or Section 10-A of the Act.
10. On perusal of the material on record, we are of the opinion
that the conclusion reached by the High Court regarding the
manner in which inspection was conducted is also not correct.
Bed occupancy at 45.30 per cent on random verification was the
claim of Respondent No.1 and 2. However, the inspection report
shows that out of required minimum of 300 patients only 3 were
available at 10.00 am on 25th September, 2017. This Court in
Kalinga (supra) has held that medical education must be taken
very seriously and when an expert body certifies that the
facilities in a medical College are inadequate, it is not for the
Courts to interfere with the assessment, except for very cogent
jurisdictional reasons such as mala fides of the inspection team,
ex facie perversity in the inspection, jurisdictional error on the
part of the M.C.I., etc. The submission relating to the cyclone
being a reason for the number of patients being less is not
acceptable. We are in agreement with the submission made on
behalf of the Appellant that the Resident Doctors are required to
be in the hospital at all points of time.
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11. In view of the large scale deficiencies found in the
inspection report dated 25.09.2017 and 26.09.2017 and in view of
Regulation 8 (3) (1) (a), the Respondent No.1 and 2 are not
entitled to claim another inspection.
12. For the aforementioned reasons, the judgment of the High
Court is set aside and the Appeal is allowed.


..............................................J
 [L. NAGESWARA RAO]
...............................................J
[MOHAN M. SHANTANAGOUDAR]
NEW DELHI;
JUNE 01, 2018

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