NATIONAL MEDICAL COMMISSION & ANR versus ANNASAHEB CHUDAMAN PATIL MEMORIAL MEDICAL COLLEGE & ORS on 10 February 2023

[2023] 1 S.C.R. 519

NATIONAL MEDICAL COMMISSION & ANR

v.

ANNASAHEB CHUDAMAN PATIL MEMORIAL MEDICALCOLLEGE & ORS

(Civil Appeal No. 966 of 2023)

FEBRUARY 10, 2023

[DR. DHANANJAYA Y CHANDRACHUD, CJI,PAMIDIGHANTAM SRI NARASIMHA ANDJ B PARDIWALA, JJ.]

Education/Educational institutions: MBBS courses –Admission – Respondent-Medical College was established in 1990with an annual intake capacity of 100 seats for the MBBS degreecourse – The renewal of its recognition became due in 2021 – On25 November 2021, a letter of permission was issued by which theapplication submitted by the Medical College for increase in theintake capacity from 100 to 150 MBBS seats for 2021-22 wasapproved, on a condition that it would be withdrawn if minimumstandard was not found to be maintained – On the basis of assessor’sreport (Inspection report), the letter of permission was withdrawnresulting in stoppage of admission for academic year 2021-22 –Writ petition filed before the High Court – High Court upheld theorder of the appellants to the extent to which the letter of permissionwas withdrawn qua 50 MBBS Seats and held that the Medical collegeis entitled to admit students for 100 MBBS seats for 2021-22 – Inthe instant appeal, this Court had stayed the operation of theoperative direction contained in the judgment of the High Courtpermitting the Medical College to admit 100 MBBS students for theacademic year 2021-22 –Despite the order of stay granted by thisCourt, the Medical College continued to admit students for 2021-22– The subsequent inspection conducted in pursuance of theinterim order of this Court did not entitle the Medical College totake the law for granted – Giving due regard to the fate of 100students, while exercising jurisdiction u/Art.142, their admissionshould not be disturbed on a condition that Medical college woulddeposit an amount of Rs 2.5 crores as penalty within a period offour weeks – The amount shall be deposited with the AIIMS Delhi –

519

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AThe amount of penalty shall not be recoverable from the students inany manner – Constitution of India – Art. 142 – Indian MedicalCouncil Act – s.11.

Disposing of the appeals, the Court

HELD : 1.When this Court was moved in these proceedings,Ban order was passed on 8 April 2022 issuing notice. This Courtwas apprised of the fact that after the judgment of the High Court,a notice to show cause was issued on 7 March 2022 to the MedicalCollege to show cause as to why the recognition which wasgranted on 15 July 2021 and the permission to start and/or conductCpost graduate courses should not be withdrawn. In the meantime,the Medical College was directed to stop admissions in pursuanceof the deficiencies which were noted during the course of theinvestigation which was carried out on 14/15 January 2022. ThisCourt stayed the operation of the operative direction containedin paragraph 37 of the judgment of the High Court permitting theDMedical College to admit 100 MBBS students for the academicyear 2021-22. The National Medical Commission and the MedicalAssessment and Rating Board were granted liberty to carry outa fresh inspection within a period of two months for the purposeof determining as to whether any deficiencies in complying withEthe required norms continue to exist. In pursuance of thedirections of this Court, an inspection of the Medical Collegewas carried out on 28/29 April 2022 for 2021-22. In view of theinspection report, the appellants have permitted the MedicalCollege to admit 100 students. The position as it has emergedbefore this Court is that despite the order of stay granted by thisFCourt, the Medical College continued to admit students for 2021-22. No application was moved before this Court for variation ofits order or for seeking permission to admit 100 students. [Paras5-7][523-G-H; 524-A-D]

2. Notwithstanding the above deficiencies, the High Court,Gwhile upholding the withdrawal of the permission to admit 50students, permitted the Medical College to continue with theadmission of 100 students. This order was stayed by this Courton 8 April 2022. Once the order of the High Court permitting theMedical College to admit 100 students for 2021-22 was stayed,H

the Medical College could not have unilaterally chosen to proceedwith the admission process. This is plainly in breach of thedirections of this Court. The Medical College has made an attemptto overreach the process of the Court. The subsequent inspectionconducted in pursuance of the interim order of this Court did notentitle the Medical College to take the law for granted. It plainlyacted in defiance of the order of this Court. [Para 11][525-H;526-A-B]

3. The issue which now remains is as regards the admissionwhich was granted to 100 students for 2021-22 in breach of theorder of stay passed by this Court. On one hand, the Court hasdue regard to the consequences which will be faced by thestudents if their admissions are disturbed, at this stage. Equally,the sanctity of the judicial process has to be observed. Therefore,in the exercise of the jurisdiction under Article 142 of theConstitution, the admissions which were granted to 100 studentsfor 2021- 22 should not be disturbed conditional on the MedicalCollege depositing an amount of Rs 2.5 crores within a period offour weeks. The amount shall be deposited with the All IndiaInstitute of Medical Sciences, New Delhi. The amount, upondeposit, shall be utilized at the discretion of the Director, AIIMSfor meeting the requirements of poor and needy patients. Theamount which has been directed to be deposited by the MedicalCollege by way of penalty shall not be recoverable from thestudents in any manner, whether for the present year or thereafter.[Para 13][526-C-F]

CIVIL APPELLATE JURISDICTION : Civil Appeal No. 966 of2023.

From the Judgment and Order dated 04.03.2022 of the High Courtof Judicature at Bombay at Aurangabad in WP No.1280 of 2022.

With

Civil Appeal No.967 of 2023.

Nidhesh Gupta, Sr. Adv., Gaurav Sharma, Dhawal Mohan, PrateekBhatia, Avijit Mani Tripathi, Mrs. Preeti Sehrawat, SiddharthDharmadhikari, Aaditya Aniruddha Pande, Bharat Bagla, Ms. KirtiDadheech, Advs. for the appearing parties.

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522SUPREME COURT REPORTS

AThe Judgment of the Court was delivered byDR. DHANANJAYA Y CHANDRACHUD, CJI.

1. Leave granted.

2. These appeals arise from a judgment dated 4 March 2022 of aDivision Bench at the Aurangabad Bench of the High Court of JudicatureBat Bombay.

3. Annasaheb Chudaman Patil Memorial Medical College[1] wasestablished in 1990 with an annual intake capacity of 100 seats for theMBBS degree course. The MBBS degree granted by the University towhich the Medical College was affiliated was recognized under Section11 of the Indian Medical Council Act 1956 for 100 seats in 1997. TheCrecognition was liable to be renewed every five years. For the academicyears 2017-18 and 2018-19, the Medical College was not grantedpermission to admit students. On 30 November 2020, the Medical Collegesubmitted an application for increase of its intake capacity from 100 to150 seats commencing from the academic year 2021-22. At the sametime, the renewal of recognition became due in 2021. During the Covid-D19 pandemic, no inspection could be conducted by the appellants. On 10May 2021, an affidavit was filed on behalf of the Medical College statingthat there were no deficiencies. The Undergraduate Medical EducationBoard of the first appellant, bearing in mind, the onset of the Covid-19pandemic granted renewal of recognition on 15 July 2021 for the batchEof students admitted for the academic session 2016-17. The recognitionwas for the academic year 2021-22, subject to the condition that thecontinuance of recognition would be done in accordance with law. Theapplication submitted by the Medical College was thereupon processedand a physical inspection was carried out on 8/9 October 2021 for increasein the intake capacity from 100 to 150 seats. A letter of intent was issuedFon 16 November 2021 for approving the increase in the intake capacity,subject to the Medical College submitting the requisite undertaking anddocuments, together with the acceptance letter. The Medical Collegefurnished the requisite documents/ undertaking, together with the letterof acceptance, on 23 November 2021. On 25 November 2021, a letterof permission was issued by which the application submitted by theGMedical College for increase in the intake capacity from 100 to 150MBBS seats for 2021-22 was approved. This was subject to the specificcondition that if during the course of surprise inspection, the MedicalCollege was found not maintaining minimum standards, the letter ofpermission would be withdrawn.H1 “Medical College”

4. In the meantime, certain complaints were received by the UnionMinistry of Health and Family Welfare alleging irregularities anddeficiencies in the infrastructure of the Medical College. A team ofinspectors was deputed to conduct a surprise physical inspection on 14/15 January 2022. During the course of the inspection, gross deficiencyof faculty, residents and clinical material, among other aspects, werefound by the assessors. After the receipt of the assessor’s report, acommunication dated 19 January 2022 was addressed to the MedicalCollege withdrawing the letter of permission for increase in the intakecapacity from 100 to 150 seats and directing the stoppage of admissionfor academic year 2021-22 in view of the gross deficiencies found duringthe course of the surprise inspection.

5. The Medical College instituted a writ petition under Article 226of the Constitution before the Aurangabad Bench of the High Court ofJudicature at Bombay. The petition was disposed of by directing theappellants to conduct an inspection of the Medical College by 30 January2022 and a final decision was directed to be taken by 3 February 2022.The petition was, thus, disposed of on 25 January 2022, on the first dateof hearing, without a counter affidavit being filed by the appellants. Thisgave rise to the filing of a Special Leave Petition[2] on 29 January 2022.An application for modification of the order of the High Court wasthereafter filed by the Medical College. The High Court having declinedto modify its judgment, Special Leave Petitions[3] were instituted beforethis Court by the Medical College. By a judgment dated 14 February2022, this Court set aside the judgments dated 25 January 2022 and 2February 2022 and restored the writ petition to the file of the High Court.Thereafter, a counter affidavit was filed on behalf of the appellants.The Division Bench, by its judgment dated 4 March 2022, partially allowedthe writ petition. The High Court upheld the order of the appellantsdated 19 January 2022 to the extent to which the letter of permissionwas withdrawn qua 50 MBBS seats. However, the High Court heldthat the Medical College is entitled to admit students for 100 MBBSseats for 2021-22 as no action was taken by the appellants for withdrawalof recognition. When this Court was moved in these proceedings, anorder was passed on 8 April 2022 issuing notice. This Court was apprisedof the fact that after the judgment of the High Court, a notice to showcause was issued on 7 March 2022 to the Medical College to showcause as to why the recognition which was granted on 15 July 2021 and 2 SLP(C) No 1710 of 2022

3 SLP(C) Nos 2234-2235 of 2022

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Athe permission to start and/or conduct post graduate courses should notbe withdrawn. In the meantime, the Medical College was directed tostop admissions in pursuance of the deficiencies which were noted duringthe course of the investigation which was carried out on 14/15 January2022. This Court stayed the operation of the operative direction containedin paragraph 37 of the judgment of the High Court permitting the MedicalBCollege to admit 100 MBBS students for the academic year 2021-22.The National Medical Commission and the Medical Assessment andRating Board were granted liberty to carry out a fresh inspection withina period of two months for the purpose of determining as to whether anydeficiencies in complying with the required norms continue to exist.

C6. In pursuance of the directions of this Court, an inspection ofthe Medical College was carried out on 28/29 April 2022 for 2021-22. Inview of the inspection report, the appellants have permitted the MedicalCollege to admit 100 students.

7. The position as it has emerged before this Court is that despitethe order of stay granted by this Court, the Medical College continued toDadmit students for 2021-22. No application was moved before this Courtfor variation of its order or for seeking permission to admit 100 students.

8. We have heard Mr Gaurav Sharma, counsel appearing on behalfof the appellants and Mr Nidhesh Gupta, senior counsel appearing onbehalf of the Medical College.

E9. The material which has been placed on the record indicatesthat serious deficiencies were noted during the course of the inspectionwhich was carried out initially, resulting in the withdrawal of permissionby the appellants for the academic year 2021-22.

10. At this stage, it may not be necessary to recapitulate in detailthe specific deficiencies which were found, save and except fromFparagraph 34 of the judgment of the High Court, which is extractedbelow:

“I.Out-patients are only about 22 by 2 PM and in-patients areonly about 39% (bed occupancy rate), even the patientsadmitted appear healthy and without any significant clinicalGsymptoms, most of the patients were sent out of hospital by5 PM. There are no surgeries and no deliveries conducted.There were only three X-rays and two ultrasounds done inthe hospital on the day of assessment.

II.The nurses’ charts had pre-recorded vitals of the patientsand also treatment instructions as administered in advanceHtill 16.01.2022 (recorded on 14.01.2022).

III.The patients admitted on 14.01.2022 were not genuine. TheyAwere looking healthy and gave evasive replies. Case recordsof many patients were not available. In the available recordscase history and treatment in many patients were not signedby any doctor or consultant. Nature of symptoms did notseem to merit admission. Orthopaedic wards had‘admissions’ for physiotherapy for knee pain. Basic andBessential parameters were not recorded in the case filesand the assessors suspected the genuineness of the records.Patients were aferbrile and no record of fever was foundin the files. In some files the temperature was recorded inadvance till 16[th] January; so also the treatment given toChave been administered in advance till 16[th] January.

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IV.The doctor on duty in the surgical ward, Dr. Swati Patilwas having BHMS degree, and she was not a regularemployee of the hospital.

V.In the pediatric ward there were 13 admitted patients ofwhom 10 were admitted on the day of inspection14.01.2022. Assessors opine that the children were lookingapparently well and were having their lunch. Symptomsreported did not match with the records. The children saidthey were not given medicines though the case filesrecordedIV fluids and medicines being given. When theassessors revisited this ward at 5 o’clock, nearly all patientsadmitted on 14.01.2022 were not found in the ward. At5.00 p.m. the orthopedics ward had no patients who wereadmitted in the morning for physiotherapy.

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VI.Census reports of medical, surgical, pediatric and orthopedicwards had even more serious errors. Daily census reportswere entered using pencil. The census report of obstetricsand gynecology ward in the last five days had newadmissions ranging between three and thirteen. However,on 14.01.2022, there were already 32 admissions till 5 p.m.In admission list of 14.01.2022 at 11.30 a.m. there were nocontact details of the patients with numbers like 1111111111,[REDACTED], etc., suggesting that the patients were notgenuine.”

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11. Notwithstanding the above deficiencies, the High Court, whileupholding the withdrawal of the permission to admit 50 students, permittedthe Medical College to continue with the admission of 100 students. This H

Aorder was stayed by this Court on 8 April 2022. Once the order of theHigh Court permitting the Medical College to admit 100 students for2021-22 was stayed, the Medical College could not have unilaterallychosen to proceed with the admission process. This is plainly in breachof the directions of this Court. The Medical College has made an attemptto overreach the process of the Court. The subsequent inspectionBconducted in pursuance of the interim order of this Court did not entitlethe Medical College to take the law for granted. It plainly acted in defianceof the order of this Court.

12. The position as it obtains at present is that the Medical Collegewas permitted to admit 100 students following the inspection which tookCplace and it has accordingly admitted 100 students for the subsequentacademic year.

13. The issue which now remains is as regards the admissionwhich was granted to 100 students for 2021-22 in breach of the order ofstay passed by this Court. On one hand, the Court has due regard to theconsequences which will be faced by the students if their admissionsDare disturbed, at this stage. Equally, the sanctity of the judicial processhas to be observed. We are, therefore, of the considered view in theexercise of the jurisdiction under Article 142 of the Constitution that theadmissions which were granted to 100 students for 2021-22 should notbe disturbed conditional on the Medical College depositing an amount ofRs 2.5 crores within a period of four weeks. The amount shall beEdeposited with the All India Institute of Medical Sciences, New Delhiand a proof of receipt shall be furnished both to the appellants and to theRegistry of this Court. The amount, upon deposit, shall be utilized at thediscretion of the Director, AIIMS for meeting the requirements of poorand needy patients. The amount which has been directed to be depositedFby the Medical College by way of penalty shall not be recoverable fromthe students in any manner, whether for the present year or thereafter.

14. The admission of the students is not being disturbed, particularlyhaving regard to the fact that they were admitted through centralcounselling in terms of the list which was furnished by the State ofMaharashtra.G

15. The appeals are accordingly disposed of.

16. Pending application, if any, stands disposed of.

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Devika Gujral(Assisted by : Rakhi, LCRA)

Appeals disposed of.