MEDICAL COUNCIL OF INDIA versus VEDANTAA INSTITUTE OF ACADEMIC EXCELLENCE PVT. LTD. AND ORS. on 1 June 2018

[2018] 5 S.C.R. 1

MEDICAL COUNCIL OF INDIA

v.

VEDANTAA INSTITUTE OF ACADEMIC EXCELLENCE PVT.LTD. AND ORS.

(Civil Appeal No. 5805 of 2018)

JUNE 01, 2018

[L. NAGESWARA RAO ANDMOHAN M. SHANTANAGOUDAR, JJ.]

Education/Educational Institutions:

Establishment of Medical College Regulations, 1999 – Regn.8(3)(1)(a) – Medical education – Inspection conducted for grantingfirst renewal for admission of students for academic year 2018-19– Several deficiencies pointed out – Writ petition by Medical Instituteseeking direction to Medical Council of India-MCI to send its Expertteam for verifying the compliance of deficiencies pointed out andto forward its recommendation to Central Government; and Unionof India to consider grant of renewal permission – High Court issueddirection to MCI to inspect the Medical College and submit a reportto Union of India – On appeal, held: Medical education must betaken very seriously and when an expert body certifies that thefacilities in a medical College are inadequate, it is not for the Courtsto interfere with the assessment, except for very cogent jurisdictionalreasons such as mala fides of the inspection team, ex facie perversityin the inspection, jurisdictional error on the part of the MCI – Onfacts, High Court erred in holding that Regn. 8(3)(1)(a) would beapplicable only to Colleges seeking second renewal – Admissionsupto second renewal would fall u/Regn. 8(3)(1)(a) – Proviso notrestricted only to second renewal cases – Even the first renewal iscovered by proviso (a) to Regn. 8(3)(1) as the language used is“upto second renewal” – Further, the Regn. 8(3)(1) provides thatan opportunity shall be given to the medical College to rectify thedefects but, the proviso contemplates that certain minimum standardsare to be satisfied – This prescription of standards for availing anopportunity to seek re-inspection not ultra vires either the Regulationor s. 10-A – Thus, in view of the large scale deficiencies found inthe inspection reports and in view of Regn. 8(3)(1)(a), medical

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Acollege not entitled to claim another inspection – Medical CouncilAct, 1956.

Allowing the appeal, the Court

HELD: 1.1 Though Regulation 8 (3)(1)(a) of theEstablishment of Medical College Regulations, 1999 wasBchallenged in the writ petition filed by respondent No.1 and 2,they did not press the relief. They restricted their challenge tothe manner in which the inspection was done and for a directionto the appellant-Council to carry out a fresh inspection. Theinterpretation of Regulation 8 (3) (1) (a) by the High Court isCpatently erroneous in as much as the High Court did not takenote of the proviso to Regulation 8(3)(1). Without a properexamination of the provision, the High Court fell in error in holdingthat Regulation 8 (3) (1) (a) would be applicable only to theColleges seeking second renewal i.e. admissions of the thirdbatch. Admissions upto the second renewal i.e. admissions toDthird batch would fall under Regulation 8 (3) (1) (a). In other words,the proviso is not restricted only to second renewal cases. Eventhe first renewal is covered by proviso (a) to Regulation 8 (3) (1)as the language used is “upto second renewal”. There is noconflict between Section 10-A (3) and (4) of the Act on one handEand Regulation 8 (3) (1) (a) on the other. Regulation 8 (3) (1) (a)is complementary to Section 10-A of the Act. Fixing minimumstandards which have to be fulfilled for the purpose of enabling amedical College to seek fresh inspection would not be contraryto the scheme of Section 10-A. In fact, Regulation 8 (3) (1)provides that an opportunity shall be given to the medical CollegeFto rectify the defects. But, the proviso contemplates that certainminimum standards are to be satisfied i.e. there should not bedeficiency of teaching faculty and/or residents more than 30 percent and/or bed occupancy should not be less than 50 per cent.This prescription of standards for availing an opportunity to seekGre-inspection is not ultra vires either the Regulation or Section10-A of the Act. [Para 9][10-B-F]

1.2 On perusal of the material on record, the conclusionreached by the High Court regarding the manner in whichinspection was conducted is also not correct. Bed occupancy atH45.30 per cent on random verification was the claim of respondent No.1 and 2. However, the inspection report shows that out ofrequired minimum of 300 patients only 3 were available at 10.00am on 25[th] September, 2017. Medical education must be takenvery seriously and when an expert body certifies that the facilitiesin a medical College are inadequate, it is not for the Courts tointerfere with the assessment, except for very cogentjurisdictional reasons such as mala fides of the inspection team,ex facie perversity in the inspection, jurisdictional error on thepart of the M.C.I., etc. The submission relating to the cyclonebeing a reason for the number of patients being less is notacceptable. It is accepted that the Resident Doctors are requiredto be in the hospital at all points of time. [Para 10][10-G-H; 11-A-B]

1.3 In view of the large scale deficiencies found in theinspection reports and in view of Regulation 8 (3) (1) (a), therespondent No.1 and 2 are not entitled to claim anotherinspection. The judgment of the High Court is set aside. [Paras11, 12][11-C-D]

Medical Council of India v. Kalinga Institute of MedicalSciences (KIMS) & Ors. (2016) 11 SCC 530 : [2016] 4SCR 403; Royal Medical Trust (Registered) v. Unionof India (2015) 10 SCC 19 – referred to.

Case Law Reference

[2016] 4 SCR 403referred toPara 6(2015) 10 SCC 19referred toPara 8

CIVIL APPELLATE JURISDICTION: Civil Appeal No. 5805of 2018.

From the Order dated 20.04.2018 of the High Court of Judicatureat Bombay in WP No. 4319 of 2018.

Vikas Singh, Sr. Advocate, Gaurav Sharma, Prateek Bhatia,Dhawal Mohan and Mrs. Depika Kalia, Advs., for the appellant.

Maninder Singh, ASG, Ranjit Kumar, Sr. Advocate, Sudhanshu S.Choudhari, V. M. Thorat, Shakul R. Ghatole, Amarjeet Singh, Ms. VimalSinha, Pranay Ranjan and Gurmeet Singh Makker, Advs., for therespondents.

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L. NAGESWARA RAO, J. Leave granted.

1. Vedantaa Institute of Academic Excellence Pvt. Ltd. andVedantaa Institute of Medical Sciences, Respondent Nos.1 and 2 hereinfiled Writ Petition No.4319 of 2018 in the High Court of Judicature atBBombay seeking a direction to the Appellant to send its Experts’ team forthe purpose of verifying the compliance of the deficiencies pointed outearlier. They also prayed for a direction to the Appellant to forward itsthrecommendation to the Central Government before 30 April, 2018. Theysought a further direction to Respondent No.3 herein, Union of India toCconsider the grant of renewal permission on the basis of therecommendations received from the Appellant. The High Court allowedthe Writ Petition and directed the Medical Council of India to inspectRespondent No.2, Medical College and submit a report to the Union ofIndia before 30[th ]April, 2018. Aggrieved thereby, the Appellant Councilhas filed the above appeal.D

2. Respondent No.1 submitted an application under Section 10-Aof the Indian Medical Council Act, 1956 (hereinafter referred to as the‘Act’) for starting a Medical College. A letter of intent was issued toRespondent No.1 after conducting an inspection. The Union of Indiaissued a letter of permission dated 31.05.2017 to Respondent No.1 toEadmit the first batch of 150 students for the academic year 2017-2018.After issuance of a letter of permission, the Respondent No.2 Collegewas included in the list of Colleges for centralised process of admissioncarried out by the State of Maharashtra. Students were allotted for theyear 2017-2018 in the centralised counselling. The inspection for theFpurpose of granting first renewal for admission of students for the academicyear 2018-2019 was conducted on 25.09.2017 and 26.09.2017. TheExecutive Committee of the Appellant Council considered the assessmentreport in its meeting held on 25.10.2017 and it was decided as under:- “The Executive Committee of the Council considered theGassessment 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 H

MEDICAL COUNCIL OF INDIA v. VEDANTAA INSTITUTE OFACADEMIC EXCELLENCE PVT. LTD. [L. NAGESWARA RAO, J.]

4. Bed Occupancy is 01% at 10 a.m. on day of assessment.

5. Wards: Majority of the wards were locked or under renovationand non-functional.

6. Data of OPD attendance, Radiological & laboratoryinvestigations are inflated.

7. There was NIL Major, NIL Minor & NIL Daycare Operationon day of assessment.

8. There was NIL woman in Labour room.

9. Nursing staff: 164 Nursing staff are available againstrequirement of 175.

10. Paramedical & Non-teaching staff: 90 Paramedical & Non-teaching 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 ofassessment.

14. 1 Mobile X-ray machine is available against requirementof 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 facultyagainst 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.

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A24. There is no CME activity during the year.

25. Other deficiencies as pointed out in the assessment report.

The Executive Committee noted that Regulation 8(3)(1)(a) of theEstablishment of Medical College Regulation (Amendment), 2010(Part II), dated 16[th ]April, 2010 and amended on 18[th ]March,B2016 provided as under:- “8(3)(1)…..

(a) Colleges in the stage of Letter of Permission upto II renewal(i.e. Admission of third batch)

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It is observed during any inspection/assessment of the institutethat the deficiency of teaching faculty and/or Residents is morethan 30% and/or bed occupancy is <50% (45% in North East,Hilly terrain etc.), compliance of rectification of deficiencies fromsuch an institute will not be considered for issue of Letter ofPermission (LOP)/ renewal of permission in that Academic Year.”

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In view of the deficiencies as noted above, the ExecutiveCommittee of the Council decided to recommend to the CentralGovt. to invoke Regulation 8 (3)(1)(a) of the Establishment ofMedical College Regulation, 1999 and disapprove the applicationof the Vedantaa Institute of Medical Sciences, Palghar,EMaharashtra under Maharashtra University of Health SciencesNashik u/s 10A of the IMC Act, 1956 for renewal of permissionof MBBS course 2[nd ]batch (150 seats) for the academic year2018-2019.”

3. The said decision of the Executive Committee was approvedFby the Oversight Committee on 16.11.2017. The Appellant by a letterdated 21.11.2017 communicated the decision of the Executive Committeeas approved by the Oversight Committee to the Union of India. By aletter dated 07.12.2017, the Respondent No. 3, Union of India directedthe Respondent College to respond to the recommendation of theGAppellant. A detailed reply was submitted by the College and even apersonal hearing was given.

4. The High Court allowed the Writ Petition filed by RespondentNo.1 and 2 mainly on two grounds. According to the High Court,Regulation 8 (3) (1) proviso (a) of the Establishment of Medical College H

MEDICAL COUNCIL OF INDIA v. VEDANTAA INSTITUTE OFACADEMIC EXCELLENCE PVT. LTD. [L. NAGESWARA RAO, J.]

Regulations, 1999 (hereinafter referred to as the Regulations) is notapplicable to the case of Respondent No.1 and 2. The relevant portion ofClause 8 (3) (1) is extracted as under:- “8 GRANT OF PERMISSION:

(3) (1). The permission to establish a medical College and admitstudents may be granted initially for a period of one year andmay be renewed on yearly basis subject to verification of theachievements of annual targets. It shall be the responsibility ofthe person to apply to the Medical Council of India for purposeof renewal six months prior to the expiry of the initial permission.This process of renewal of permission will continue till suchtime the establishment of the medical College and expansion ofthe hospital facilities are completed and a formal recognition ofthe medical College is granted. Further admissions shall notbe made at any stage unless the requirements of the Councilare fulfilled. The Central Government may at any stage conveythe deficiencies to the applicant and provide him an opportunityand time to rectify the deficiencies.

Note: In above clause, “six months” shall be substituted by “asper latest time schedule”

PROVIDED that in respect of a) Colleges in the stage ofLetter of Permission upto II renewal (i.e. admission of thirdbatch)

If it is observed during any inspection/assessment of the institutethat the deficiency of teaching faculty and/or Residents is morethan 30% and/or bed occupancy is <50% (45% in North East,Hilly terrain, etc.), compliance of rectification of deficiencies fromsuch an institute will not be considered for issue of Letter ofPermission (LOP)/renewal of permission in that Academic Year.”

5. The other point which found favour with the High Court is themanner in which the inspection was conducted. The High Court heldthat the inspection conducted by the Assessors was not fair.

6. Mr. Vikas Singh, learned Senior Counsel appearing for theAppellant submitted that findings recorded by the High Court that A

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8SUPREME COURT REPORTS

ARegulation 8 (3) (1) is not applicable to the Respondent College as it hadsought for first renewal is clearly erroneous. He submitted that the HighCourt lost sight of the first proviso to Regulation 8 (3) (1). He contendedthat there is no ambiguity in the language of the first proviso to Regulation8 (3) (1) which covers Colleges upto the second renewal. According tothe said Regulation, Institutions having deficiency of teaching facultyBand/or residents more than 30 per cent and/or bed occupancy less than50 per cent will not be considered for renewal of permission for thatacademic year. In view of the large scale deficiencies found in theinspection conducted on 25.09.2017 and 26.09.2017, Mr. Singh submitsthat there is no question of an opportunity being given to RespondentCNo.1 to rectify the deficiencies. He also urged that the inspection wasdone strictly in accordance with the Assessors’ Guide issued by theMedical Council of India. He pointed out that the general instructionsissued to the Assessors clearly shows that it was mandatory to verifythe attendance sheet of every department (completed before 11.00 am), signed by the faculty present on the day of assessment and duly counter-Dsigned by the Head of Department. According to the Assessors’ Guidethe institutions should be asked to submit daily average clinical data forthe last 12 months and clinical data of the first day of assessment. Bedoccupancy was to be verified at 10.00 am, whereas OPD, Laboratoryand Radiological Investigation data etc. are to be verified at 2.00 pm onEthe first day of assessment. In respect of verification of teaching facultyand resident doctors, the Assessors’ Guide provides for checking offaculty attendance before 11.00 am on the first day of assessment. Onlyfaculty/residents who signed the attendance sheet before 11.00 am areto be verified. No verification should be done for the faculty/residentscoming after 11.00 am. Mr. Vikas Singh, learned Senior Counsel took usFthrough the inspection notes to submit that the inspection done by theassessment team cannot be found fault with. He also relies upon thejudgment of this Court in Medical Council of India v. Kalinga1Institute of Medical Sciences (KIMS) & Ors., to state that thereport of the Experts should not be interfered with by this Court.G

7. Mr. Maninder Singh, learned Additional Solicitor General,appearing for the Union of India submitted that the provisos to Regulation8 (3) (1) was inserted with a view to ensure that Institutions which donot satisfy the minimum infrastructure and faculty cannot to be given an 1 (2016) 11 SCC 530- Para 24H

opportunity to rectify their defects. According to him, the standards fixedby the Medical Council of India are the bare minimum and have to bestrictly complied with to ensure the maintenance of basic minimumstandards of medical education. Any lenience shown by this Court inproviding an opportunity to such Institutions to rectify the defects will havea cascading effect in the succeeding years and would result in Collegescontinuing to function with deficiencies as well as producing half bakedand poor quality doctors. He showed us the predictions made by theMeteorological Department from 20[th ]September, 2017 to 26[th ]September,2017. He submitted that thunderstorm and heavy rain is common in coastalareas and the situation was not as dangerous as projected by RespondentNo.1 and 2. He further submitted that the minimum requirement of facultyand residents is 70 per cent. He stated that if 70 per cent of the strengthof residence had to be present in the hospital on 24.09.2017 (i.e. theprevious day of inspection), it is inconceivable that there could be shortageof 84 per cent teachers and 87 per cent of residents on the date ofinspection. He also stated that a natural calamity like cyclone would resultin increase in the number of patients.

8. Mr. Ranjit Kumar, learned Senior Counsel appearing for theRespondent No.1 and 2 supported the judgment of the High Court. Herelied upon the judgment of this Court in Royal Medical Trust2(Registered) v. Union of India to support his submission that anopportunity has to be given to a Medical Institute to rectify thedeficiencies. He countered the submission of learned Senior Counselfor the Medical Council of India by submitting that the Regulations cannotover-ride the statute. According to him, Section 10-A as interpreted bythis Court entitles the Respondent College to be provided with anopportunity to cure the defects pointed out during the inspection. Suchprovision cannot be over ridden by a Regulation. He relied upon theprediction of cyclone whereby the people of the locality were asked tostay indoors. He contended that a request was made to the team ofAssessors to have another assessment on the same day. He furthersubmitted that the inspection was not conducted in a fair manner and thereport does not represent the correct picture. If another inspection isdone by the Medical Council of India to verify the facilities available inthe hospital and the College, the College would be able to satisfy therequirements. He relied upon the decision taken by the Medical Council ABCD

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Aof India in directing fresh inspection to be conducted in respect of a fewColleges where the deficiencies were more than the minimum prescribedin Regulation 8 (3) (1) (a). In reply to the submissions of Mr. RanjitKumar on this point Mr. Vikas Singh stated that a second inspection waspermitted to be done only in respect of Government Medical Colleges.

B9. Though Regulation 8 (3) (1) (a) was challenged in the WritPetition filed by Respondent No.1 and 2, they did not press the relief.They restricted their challenge to the manner in which the inspection wasdone and for a direction to the Appellant-Council to carry out a freshinspection. The interpretation of Regulation 8 (1) (a) by the High Courtis patently erroneous in as much as the High Court did not take note ofCthe proviso to Regulation 8(3)(1). Without a proper examination of theprovision, 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 uptothe second renewal i.e.admissions to third batch would fall under Regulation 8 (3) (1) (a). InDother 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 anyconflict between Section 10-A (3) and (4) of the Act on one hand andRegulation 8 (3) (1) (a) on the other. Regulation 8 (3) (1) (a) iscomplementary to Section 10-A of the Act. Fixing minimum standardsEwhich have to be fulfilled for the purpose of enabling a medical Collegeto seek fresh inspection would not be contrary to the scheme of Section10-A. In fact, Regulation 8 (3) (1) provides that an opportunity shall begiven to the medical College to rectify the defects. But, the provisocontemplates that certain minimum standards are to be satisfied i.e. thereFshould not be deficiency of teaching faculty and/or residents more than30 per cent and/or bed occupancy 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 theAct.

G10. On perusal of the material on record, we are of the opinionthat the conclusion reached by the High Court regarding the manner inwhich inspection was conducted is also not correct. Bed occupancy at45.30 per cent on random verification was the claim of RespondentNo.1 and 2. However, the inspection report shows that out of requiredminimum of 300 patients only 3 were available at 10.00 am on 25[th]H

September, 2017. This Court in Kalinga (supra) has held that medicaleducation must be taken very seriously and when an expert body certifiesthat the facilities in a medical College are inadequate, it is not for theCourts to interfere with the assessment, except for very cogentjurisdictional reasons such as mala fides of the inspection team, ex facieperversity 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 numberof patients being less is not acceptable. We are in agreement with thesubmission made on behalf of the Appellant that the Resident Doctorsare required to be in the hospital at all points of time.

11. In view of the large scale deficiencies found in the inspectionreport 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 anotherinspection.

12. For the aforementioned reasons, the judgment of the HighCourt is set aside and the Appeal is allowed.

Nidhi Jain

Appeal allowed.

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