NMC Bill will be the mother of quackery: TMC MP and IMA chief Santanu Sen

For the last several months, the Union government was indirectly controlling the MCI through a board of governors, says Sen

Santanu Sen is a doctor and a Trinamool Congress MP in the Rajya Sabha, and heads the Indian Medical Association (IMA). In an interview to Aditi Phadnis, he talks of his reservations about the National Medical Commission Bill. Edited excerpts:

You made your maiden speech about the National Medical Commission and you slammed the government’s proposal to make medical education uniform across India. Now, doctors across the country are on strike in protest. Why?

The National Medical Commission Bill was introduced on December 29, 2017, and it was first placed in Parliament on January 2 last year. Our fight against the NMC Bill is because of the following reasons: First, this Bill is undemocratic. Why? The existing Medical Council of India used to be formed through an election in all the states of the country. It would have elected representatives from the states.

And the purpose of the MCI was…?

… To regulate medical education in the country! To give the licence (to medical colleges), to recognise, to fix curriculum … medical education used to be regulated by this autonomous body. 

But weren’t there a lot of problems with the whole process of recognition, de-recognition, licences…? The CBI also conducted an enquiry, after which the government decided to change the way medical education is structured in India…

Yes, your question is the right one. But my point is: There are many issues, many complaints about this government. If there is a complaint about any institution, does it mean you dissolve the institution? Is that the solution?

For the last several months, the Union government was indirectly controlling the MCI through a board of governors. You could say that for the last nine months, it was being governed by the government.

Earlier, it was the MCI to which the government would send all requests for medical colleges: The MCI would conduct rigorous checks and formalities of the institutions and send its recommendation to the government.

Now, in this NMC, there is no provision for election. It is by nomination. And if you see the constitution, there are 25 members and almost all are government persons — hand-picked from the central government, or central government employees…

Does that make them less competent?

Let me tell you…The minister said of the 25 members, 21 were doctors. But who are they? All are central government employees: Director of AIIMS, Director of JIPMER…Will a central government employee ever go against the decision of the government when it comes to giving the licence or recognition? 

If there is no autonomy, how can such an important institution function without vested interests driving it?

We believe the NMC is anti-federal. The MCI used to have at least three members from every state in India. But in the NMC 

proposed by government, there will be six members nominated from states and union territories and five members from the elected state council members. According to this formula, every state will get the opportunity to have its nominee on the council once every 12 years and every state council nominee once in 14 years. There could not have been a worse marginalisation of the states. For instance, if the state of Delhi is represented this year, 2019, the next opportunity will arise in 2031 and 2033.

The Bill is also anti-poor. As of now, even according to the guidelines of the Supreme Court, capitation fees of private medical colleges were governed by a regulatory body. If I run a medical college, my capitation fee cannot be anything I want.

In India there are almost 530 medical colleges, of which 270 are run by the government and 260 are private. The admission fee of 85 per cent seats of private medical colleges is regulated by the government. According to Clause 10(i) of this Bill, not only would 50 per cent of the seats be sold freely but also for the remaining 50 per cent, this Board will only fix the criteria but will not prescribe the capitation fee. So, indirectly, hundred per cent seats of all private medical colleges will be for sale. Do you think after the National Medical Commission Bill is passed, a meritorious student from a remote rural district of the country can even dream of becoming a doctor? It will indirectly lead to mushrooming of private medical colleges and nothing else.

So right now, isn’t it the case that you can charge any amount as capitation fee?

No, that is only for the NRI quota, which is only 15 per cent. Now there is a cap on capitation fee. In this Bill, for the remaining 50 per cent, they will prescribe the guideline for capitation fee, not the capitation fee per se. 

So if a meritorious student tries and fails to get one of the 50 per cent seats, he or she will be overlooked by the system. The student who will get admission will be the child of a person who can afford to pay crores of rupees as capitation fee. What kind of doctor will that make him or her?

Moreover, this Bill says that inspecting new medical colleges should be discretionary. What do you mean by discretionary? Today, I open a medical college. It will be absolutely discretionary whether my medical college will be inspected or not. I will collect crores and crores of rupees as capitation fee. My medical college will not be inspected for three-four years. After three years, I might have accumulated crores and crores of rupees. They might shut it down whenever they inspect it: But I would get away. What will happen to the students left in the lurch? What will be the fate of those students?

There are many other aspects of the Bill that we oppose. This Bill is going to be the mother of quackery in India because AYUSH (Ayurveda, Yunani, Siddha, homoeopathy) doctors are going to be treated on a par with trained doctors. And not just these. The Bill allows lab technicians, ECG technicians, 

X-ray technicians, compounders, ambulance drivers, etc. who are directly or indirectly associated with medical system to get the licence and practise as doctors.

The Bill has now been passed. What is your next step?

Because of the efforts of the IMA, and all the pressure put by us, they have agreed to listen to four of our amendments. State representation has been corrected; On Ayush the minister has replied in his own way — let us see what he does. He has said he will set up a committee to decide who will be given the licence. But until it is made clear by the government, the IMA will continue to agitate.