Comment

Rulings that impact a State’s medical infrastructure

Tamil Nadu has been in the middle of a journey for some time to set up a medical college in every district. The aim is to ensure efficient delivery of advanced medical care to residents. This has required having specialist and super-specialist doctors to staff various departments in the medical colleges and the hospitals in the State.

Policies by the State

To ensure full value to its investment and maintain institutional continuity, the State brought in three policies. A quota was created wherein 50% of the seats in government medical colleges was earmarked for doctors working in government institutions (in-service candidates) with the stipulation that they needed to work in the Tamil Nadu Medical Services until superannuation. To absorb trained super-specialists who are not associated with Tamil Nadu Medical Services (non-service candidates), it created a bond for them to serve in government hospitals (after the completion of their training) for not less than two years; it also created a domicile requirement for them to appear for the super-specialty entrance examination.

Editorial | Tamil Nadu’s case against NEET

Until 2015-16, admission to Tamil Nadu super-specialty medical seats was on the basis of a State entrance exam, with domicile requirement and in-service quota. The domicile requirement for the admissions to super-specialty courses required by the States of Tamil Nadu, Andhra Pradesh and Telangana was dismantled in 2016 following a judgment by a Supreme Court Bench comprising Justices Dipak Mishra and Prafulla C. Pant. They indirectly invoked the nine-judge Bench judgment in Indra Sawhney etc. vs Union Of India (1992) which requires super-specialty seats in medicine to be outside the ambit of reservation, with expression of no plausible reasons associated with domicile or reservation or ‘efficiency of administration’.

With the introduction of the National Eligibility cum Entrance Test-Super Specialty (NEET-SS) conducted by the National Board of Examinations from 2017-18, State governments were robbed of their ability to conduct entrance examinations and counselling for super-specialty seats created in their medical colleges as the States were required to surrender 100% of their seats to the all-India quota. As an extension, the in-service quota stood null and void.

In-service quota, directive

A writ petition (Writ Petition (Civil) No. 196 of 2018) was filed by the Tamilnadu Medical Officers Association (TNMOA) on behalf of in-service doctors in Tamil Nadu to contest the removal of 50% in-service quota for post-graduate medical courses. The Constitution Bench disposed of this case on in-service quota with an order on August 31, 2020, stating that except for the determination of minimum standards and coordination, the State’s power in regulating medical education is preserved. They stated that the State authorities may provide quota for in-service doctors from within the State’s own merit list, also adding that aspiring in-service doctors must clear the NEET examination with the minimum prescribed marks.

 

The Tamil Nadu G.O.

Extrapolating the directions of the Constitution Bench, the Health and Family Welfare Department of the Government of Tamil Nadu on November 7, 2020, issued G.O. (Ms) No. 462. Through this G.O., the Government of Tamil Nadu sought to implement a 50% quota in super-specialty seats in the State for in-service candidates. As the admission process was in the final stages, the Supreme Court Bench, on November 27, 2020, decided not to permit a quota for in-service doctors for the year 2020-21 alone.

With doubts around the line of the judgment in TNMOA vs Union of India and the validity of the G.O. (Ms) No. 462 by the Government of Tamil Nadu, it remains to be seen what trajectory the Supreme Court’s decisions will take.

Administration and inclusion

Maintenance of the efficiency of administration is an argument which is consistently invoked by the Supreme Court through Article335 of the Constitution, to negate demands for reservations/quotas. It is here that one is motivated to question the working definition of “efficiency”, “merit” and “efficiency of administration” in government that the courts abide by. A welcome move in this regard is the judgment by the two-judge Supreme Court Bench (Justices Uday Umesh Lalit and D.Y. Chandrachud) in B.K. Pavitra vs Union of India (2019) which nudges the courts to define the multidimensional term of “efficiency of administration” that is grounded in inclusion.

 

This definition should have a systems-view of the cascading impact that the removal of domicile requirement and in-service quota can have on the integrity of the State medical infrastructure. On August 25, 2021, the Director of Medical Education issued a letter to the deans of medical colleges requesting them to obtain an undertaking from the non-service super-specialty doctors of 2020-21 who have not opted or are not willing to take up posting even when vacancies are available in their specialty departments. It is understood that nearly 80% of the other State super-specialty candidates, who constitute more than 50% in government medical colleges in Tamil Nadu did not attend counselling held for posting. In Tamil Nadu, with domicile and in-service quota, the percentage of in-service candidates in super-specialty seats used to hover around 40%. But with removal of domicile and in-service quota, in the post-NEET-SS scenario, the percentage of in-service candidates has come down to as low as 6%.

It is here that the point raised by Advocate Wilson in Dr. Prerit Sharma vs Dr. Bilu B.S. (2020), invoking the Supreme Court judgments permitting in-service quota in super-specialty medical courses as seen in K. Duraisamy and Ors. vs State of T.N. (2001) 2 SCC 538 and Modern Dental College and Research Centre and Ors. vs State of Madhya Pradesh and Ors. (2016) 7 SCC353, assumes greater importance.

With the sustenance of the medical infrastructure intimately linked to the delivery of public health which the States are responsible for through the Constitution, one is left to wonder why the higher judiciary consistently rules against the interventions by the State to maximise the outcomes through domicile, quota for in-service candidates and bond requirements.

Dr. Yazhini P.M. is a general practitioner based in Chennai. Jeyannathann Karunanithi is an independent policy analyst and a water professional, also based in Chennai. The views expressed are personal


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Printable version | Oct 19, 2021 10:05:28 PM | https://www.thehindu.com/opinion/op-ed/rulings-that-impact-a-states-medical-infrastructure/article36619937.ece

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