HC slaps Rs 1 Lakh Compensation on NMC, State, provides relief to PwD Doctor Denied SRship

Jaipur: The Rajasthan High Court recently granted relief to a doctor with a benchmark disability, whose application for the post of Senior Residentship was rejected by the State Government authorities as the doctor had crossed the age of 45 at the time of application. Although the doctor argued that being a PwD candidate, he was allowed to get a 5-year age relaxation, the authorities including the National Medical Commission (NMC) opposed his plea.

While considering his petition, the HC bench of Justice Sameer Jain allowed him the age relaxation and directed the NMC and the State to pay Rs 1 lakh cost, to be divided equally, for the delay and hardship caused to the petitioner.

Granting relief to the candidate, the court referred to the Rights of Persons with Disabilities Act 2016 and noted, “…that the provisions of the Act of 2016 and the corresponding Rules of 2018 shall be applicable upon the persons with benchmark disabilities in addition to the regulations formulated under the NMC Act of 2019 nomenclatured as the Teachers Eligibility Qualifications in Medical Institutions Regulations 1998, for achieving the intended benefit of the newly introduced Rule 6A of the Rules of 2018 and also, Annexure-8 i.e. Circular dated 01.12.2021, as issued by the State Government, which provide for the grant of age relaxation for candidates with benchmark disabilities in matters of direct recruitment.”

“As a result, the Regulations of 1998 cannot be permitted to operate in isolation, as a natural consequence of said operation, shall render the benefits enumerated under the Act of 2016 and the corresponding Rules of 2018, otiose,” it held.

Referring to the issue of employment of disabled persons, the Court further observed, “Conclusively, it is noted that employment is a key factor in the empowerment and inclusion of people with disabilities in the society. It is an unnerving fact of the present times that disabled individuals are out of employment, not because their disability acts as a hindrance in their way of functioning; but rather, it is the social and practical barriers created by the society that prevent them from joining the workforce in full effect. As a result, many disabled individuals, who are equally competent as those sans said disabilities, live in poverty due to the denial of their right to make a useful contribution to their own lives and also, to the lives of their families and community. Therefore, in such times, when beneficial pieces of legislation are put in place in the society, equally backed by the practice of leading institutions in the country, the same ought to be duly honoured, so as to not render their intended benefits counterproductive.”

The petitioner, a person with a benchmark disability to the extent of 40%, is working as a Senior Demonstrator with the Medical Education Department. After completing his PG in MD Pediatrics in the OBC PwD Category, he applied to serve the State as Senior Resident on 01.09.2023. However, his name was not on the merit list since the petitioner doctor had crossed the prescribed upper age limit of 45 years.

Challenging the rejection of his candidature, the petitioner approached the High Court and his counsel contended that in terms of Rule 6A of the Rules of 2018, he was entitled to get age relaxation. Therefore, he argued that if granted the said relaxation, his candidature would not have been rejected. 

He also pointed out that the Instruction Booklet for allotment to serve the State Government on the post of Senior Resident, provides 4% horizontal reservation for candidates with specified disabilities as per the Rights of Persons with Disabilities Act 2016 and the corresponding Rules of 2018.

The petitioner doctor’s counsel also referred to the fact that the All India Institute of Medical Sciences (AIIMS) Jodhpur also granted age relaxation to persons with benchmark disabilities to the extent of 10 years for PwD-General Candidates, 13 years for PwD-OBC Candidates and 15 years for PwD-SC/ST Candidates. He also pointed out that on a pan-India basis, several medical colleges such as Dr. Ram Manohar Lohia Hospital, New Delhi, Satyawadi Harish Chandra Hospital New Delhi have also granted age relaxation for persons with disabilities.

Further, the doctor’s counsel relied on the notification dated 14.10.2021, issued by the Department of Social Justice and Empowerment Directorate of Specially Abled Persons, providing reservation of vacancies for persons with disabilities. Moreover, as per the newly inserted Rule 6A, a further age relaxation of 5 years is granted to persons with disabilities, in addition to that already provided in the distinct services rules applicable to the different candidates. He also pointed out that in compliance with the circular dated 14.10.2021, the State Government also considered the aspect and provided for the grant of age relaxation to the extent of 5 years through a circular dated 01.12.2021.

On the other hand, the counsel for NMC, Mr. Angad Mirdha argued that the action of the State authorities in rejecting his candidature on the ground of the petitioner being over-age, was purely in consonance with the settled position of law and therefore, warranted no interference of the Court.

In this regard, the counsel submitted that the subject advertisement so issued for the post of Senior Resident, in categoric terms, has specified that the age limit beyond the period of 45 years, at the time of initial appointment, shall make the candidate ineligible for the post of Senior Resident, as the same would be dehors the norms of NMC Act, 2019 and the Regulations of 1998, as amended in the Year 2022 nomenclature as Teacher Eligibility and Minimum Qualification in Medical Institutional Regulations 1998.

The NMC counsel also contended that it was a settled law that when there are specific statutory regulations created under List I of the 7th Schedule, higher standards of medical education ought to be maintained in the country. It was further submitted that the services of Senior Residents form part of the backbone of all major Government Hospitals, for which the legislature in its own wisdom has prescribed the upper age limit of 45 years and therefore, no deviation can be made from the same.

Therefore, the counsel for the Commission argued that the provisions of the Act of 2016 and the Rules of 2018 could not be applied in the present factual matrix. Finally, the counsel relied on Article 254 of the Constitution of India and submitted that in the present set of facts, the NMC Act of 2019 shall assume applicability, as opposed to the Rules of 2018.

While considering the matter, the HC bench noted that through the notification dated 14.10.2021, in the exercise of powers conferred vide Section 101(1) and 101(2) of the Act of 2016, the State Government/Department of Social Justice and Empowerment issued an amendment notification in the Rajasthan Gazette on 21.10.2021, where a novel Rule 6A was introduced in the erstwhile Rules of 2018. As per the concerned Rule 6A, “The maximum age limit prescribed for direct recruitment in the relevant service rules shall be relaxed by 5 years for persons with benchmark disabilities specified under rule 5. Such age relaxation shall be in addition to the age relaxation already provided to different categories in relevant service rules.”

Referring to this, the HC bench noted,

“That even a cursory reading of Rule 6A makes it abundantly clear that the said Rule provides for a relaxation in age for the candidates with benchmark disabilities, by an extent of 5 years, in matters of direct recruitment.”

The Court noted that in compliance with the notification dated 14.10.2021, the State issued a circular on 01.12.2021 and considering this aspect, provided for the grant of age relaxation to the extent of 5 years in matters of direct recruitment concerning persons with benchmark disabilities.

Further, the bench observed that Section 96 of the Act of 2016 provided that the provisions of the Rights of Persons with Disabilities Act 2016 shall be in addition to, and not in derogation of, the provisions of any other law for the time being in force. “In essence, Section 96 stipulates that the mere enactment of the Act of 2016 shall not bar the application of any other provisions of law which are presently in force…Resultantly, Section 96 makes it very clear that the benefits qua the disabled persons shall be in addition to and never in derogation of, any other laws for the time being in force,” noted the Court.

The High Court also perused the Advertisement/Instruction Booklet, as issued by the respondents for recruitment on the post of Senior Resident, read with the Regulations of 1998, which categorically provided that the recruitment on the post of Senior Resident would be for a period not exceeding 3 years, and the graduate who would apply for the said post, must be below the age of 45 years at the time of the initial appointment. The Court also noted that at the time of initial appointment i.e. in the Year 2023, the petitioner was over the age of 45 years.

“In this foregoing background, when it is an admitted fact that the petitioner is an individual with a benchmark disability, who is qualified to avail the benefit of reservation accorded to PwD candidates, the only impediment qua the petitioner’s selection is the rider enumerated under the NMC Act of 2019 and the Regulations of 1998, as amended in the Year 2022, which provide for the upper-age limit for recruitment on the post of Senior Resident to be 45 years on the date of initial appointment,” the bench noted at this outset.

Therefore, the Court noted that the only pretext for which the petitioner’s candidature was rejected was that he was over-age as per the stipulations of the advertisement. 

The bench was considering the question of whether the provisions of the Act of 2016 would be applicable to the candidates in addition to the regulations formulated under the NMC Act of 2019 i.e. the Teachers Eligibility Qualifications in Medical Institutions Regulations 1998 or the latter would assume applicability in isolation of the former. 

At this outset, the Court noted that back in 2007, India ratified the United Nations Convention on the Rights of Persons with Disabilities. The Convention laid down certain principles to be followed by the signatory States for empowerment of persons with disabilities. It required signatory States to make appropriate changes in law as well as in policy to give effect to the principles of the Convention. Correspondingly, the Act of 2016 was promulgated with the basic aim/object of respecting the difference and accepting the persons with disabilities as part of human diversity and humanity, whilst bestowing them with equal opportunities in all public spheres.

“Therefore, it goes without saying that the Act of 2016 is a beneficial piece of legislation, major features of which include nondiscrimination, participation, equality of opportunity and inclusion of disabled persons within the society. In order to confer statutory backing upon the noted features, the Act of 2016, by way of Section 2(h) and 2(r) has defined ‘discrimination’ and ‘persons with benchmark disabilities’. Moreover, to pave the way for respectable consideration, participation in society and providing equality of opportunity and acceptance, Section 34 has provided for ‘reservation’ which is to be provided by the appropriate Government,” noted the Court.

“Accordingly, in the given facts and circumstances of the case, it is noted that the subject Advertisement for recruitment on the post of Senior Resident i.e. Annexure-3, has duly provided for reservation for PwD candidates, to the extent of 4%, in compliance of the provisions of the Act of 2016 and the corresponding Rules of 2018. Therefore, once reservation as per the Act of 2016 and the corresponding Rules of 2018 is granted for recruitment on the post of Senior Resident, then full swing ought to be granted to the provisions of the said Act and Rules, and a liberal view ought to be taken on the aspect of age relaxation, as is already provided by the newly inserted Rule 6A of the Rules of 2018,” it further observed.

The bench also noted that in exercise of the powers granted under Section 101(1) and 101(2) of the Act of 2016, the Government of Rajasthan promulgated the Rules of 2018, which was amended by the notification dated 14.10.2021, to include the newly inserted Rule 6A which made it abundantly clear that in matters of direct recruitment, the said Rule would provide for a relaxation in age for those candidates with benchmark disabilities, by an extent of 5 years.

“Therefore, at this juncture, taking note of the fact that the concerned Advertisement/Instruction Booklet for recruitment on the post of Senior Resident (Annexure-3), by way of Clause 4, provides for reservations for PwD candidates in compliance of the Act of 2016 and the corresponding Rules of 2018, then in such an eventuality, for the same recruitment process, the newly inserted Rule 6A of the Rules of 2018 shall also assume relevancy, providing for age relaxation of five years to the candidates with benchmark disabilities,” noted the Court.

It clarified that the authorities cannot apply one of the provisions of the Rules of 2018, while ignoring the other and noted, “As a result, the respondents, for the same recruitment process, cannot pick and choose the applicability of the provisions of the Rules of 2018, whereby on the one hand, in compliance of the said Rules, they provide for horizontal reservation to the extent of 4% for persons with disabilities, but on the other hand, refuse to grant age relaxation in terms of Rule 6A, especially in the overarching circumstances whereby it is an admitted position that the All India Institute of Medical Sciences (AIIMS) Jodhpur, vide Annexure-4, has granted age relaxation to persons with benchmark disabilities to the extent of 10 years for PwD-General Candidates, 13 years for PwD-OBC Candidates and 15 years for PwD-SC/ST Candidates.”

When encountered with the task of interpreting the 2016 Act and its corresponding Rules of 2018, the Court underlined that “in order to render social justice amongst the persons with disabilities, candidates belonging to said categories must be awarded proportionally equal opportunities to present a level playing field and provide them with equal opportunities for further acceptance in the society. A harmonious interpretation of the Act of 2016 with the Rules of 2018, especially the newly inserted Rule 6A shall facilitate greater participation in public recruitment for persons with disabilities, which shall inadvertently lead to nondiscrimination with their peers, resulting into equality of opportunity and inclusion of disabled persons within the society.”

The Court observed that “the provisions of the Regulations of 1998/NMC Act of 2019 providing for the upper age limit of 45 years ought to be read in conjunction with Rule 6A of the Rules of 2018, providing for age relaxation to the extent of 5 years.”

It opined that the “intent behind the inclusion of Rule 6A in the applicable Rules of 2018 is to present a level playing field to the candidates with benchmark disabilities, by reducing the upper-age limit as prescribed by the respective statutes, so that such candidates may have greater inclusion and acceptance in vocational fields of study and practice, which were once amiss of their services. Therefore, the benefit which has been given to the candidates with benchmark disabilities vide Rule 6A and also, Annexure-8 i.e. Circular dated 01.12.2021, as issued by the State Government, cannot be taken away from such candidates by subjecting the said Rule and/or Circular, to such conditions of the Regulations of 1998, which would render the intended benefit otiose.”

Referring to the argument that the age relaxation cannot be granted as the advertised post of Senior Resident forms part of the backbone of the State Government’s medical services, the Court observed that the argument was “misplaced”, “especially considering the fact that the State Government, by its own volition, has also made the age of retirement for Senior Medical Professors extendable from 60 to 70 years.”

Allowing the petition, the Court noted that the tenure of the advertised post of Senior Resident has already commenced, which only spans for a limited period of 3 years. Therefore, the Court directed the authorities to allow the petitioner to join the same with immediate effect and it also levied a cost of Rs 1 lakh on NMC and the State, to be divided equally, for the delay and hardship caused to the petitioner, who is a meritorious candidate, subjected to undue hindrances, on account of the unsubstantiated, merit-less and counterproductive obstacles.

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/rajasthan-hc-srship-239904.pdf

Also Read: NMC to abolish Age limit of 45 years prescribed for Senior Residents

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PGIMER Chandigarh Gets CDSCO Panel Nod to Study Bedaquiline

New Delhi: Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh has got approval from the Subject Expert Committee (SEC) functional under the Central Drug Standard Control Organisation (CDSCO) to conduct the academic trial of protocol titled, “A prospective, randomized study to evaluate the efficacy, safety, and pharmacokinetic-pharmacodynamics of Bedaquiline based regimen in multibacillary leprosy not responding to WHO-MDT”.

This came after the applicant presented the proposal for a grant of permission for the conduct of an academic trial which protocol titled, “A prospective, randomized study to evaluate the efficacy, safety and pharmacokinetic-pharmacodynamics of Bedaquiline based regimen in multibacillary leprosy not responding to WHO-MDT before the committee.”

Bedaquiline is a newly FDA-approved anti-TB drug, having a unique mechanism of action i.e. causes inhibition the proton pump activity of the ATP synthase in M. tuberculosis and targets the energy metabolism. It is found to be active within macrophages and is a promising agent in shortening the duration of anti-TB treatment. It has shown promising results in preclinical and clinical studies and it seems to be a good option for MDR and XDR-TB.

It acts by targeting subunit c of the ATP synthase of M. tuberculosis, leading to inhibition of the proton pump activity of the ATP synthase. Thus, the compound targets bacillary energy metabolism. ATP synthase is a critical enzyme in the synthesis of ATP for M. tuberculosis. The binding of bedaquiline to the oligomeric and proteolipic subunit c of mycobacterial ATP synthase leads to the inhibition of ATP synthesis. This leads to the death of mycobacteria.

At the recent SEC meeting for antimicrobial and antiviral held on 9th May 2024, the expert panel reviewed the proposal presented by PGIMER, Chandigarh for the grant to conduct the academic trial to evaluate the efficacy, safety, and pharmacokinetic-pharmacodynamics of Bedaquiline-based regimen in multibacillary leprosy not responding to WHO-MDT (WHO recommended multidrug therapy regimens).

After detailed deliberation, the committee recommended the conduct of an academic trial as per the protocol presented by the applicant.

Also Read: Submit Data on Paracetamol-Tapentadol Combination: CDSCO Panel tells MSN Laboratories

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CDSCO Panel approves AstraZeneca Pharma’s Benralizumab solution for Injection in auto-injector

New Delhi: Granting the local phase III clinical trial waiver, the Subject Expert Committee (SEC) functional under the Central Drug Standard Control Organisation (CDSCO) has approved AstraZeneca Pharma’s Benralizumab solution for Injection 30 mg/ml in auto-injector for the indication of “as an add-on maintenance treatment for severe asthma with an eosinophilic phenotype in adult patients”.

However, this approval is subject to the condition that the firm should conduct the Phase IV clinical trial to generate more data on the Indian population with respect to the safety, functionality, and reliability of the auto-injector.

This came after AstraZeneca Pharma presented their proposal for approval of Benralizumab solution for Injection 30 mg/ml in Auto-injector for the indication of “as an add-on maintenance treatment for severe asthma with an eosinophilic phenotype in adult patients” with the request of local phase-III trial waiver.

Benralizumab is a monoclonal antibody used to treat severe eosinophilic asthma. Benralizumab is a humanized recombinant monoclonal antibody of the isotype IgG1k immunoglobulin that specifically binds to the alpha chain of the interleukin 5 receptor (IL-5R) expressed on eosinophils and basophils. It inhibits the binding of IL-5 as well as the hetero-oligomerization of the alpha and beta subunits of the IL-5R, thus blocking signal transduction. It is an afucosylated IgG which gives it a high affinity for the FcγRIIIα receptor in natural killer cells, macrophages, and neutrophils.

At the recent SEC meeting for Pulmonary held on 21st May 2024, the expert panel reviewed the proposal for approval of Benralizumab solution for Injection 30 mg/ml in Auto-injector for the indication of “as an add-on maintenance treatment for severe asthma with an eosinophilic phenotype in adult patients” with request of local phase-III trial waiver.

The committee has noted that the Benralizumab solution for 30 mg/ml injection in a pre-filled syringe (PFS) has already been approved in India for the same indication.
The committee has also noted that Benralizumab solution for Injection 30 mg/ml in auto-injector is approved in the US, Great Britain, Europe, Singapore, Australia, etc.

After detailed deliberation, the committee has recommended approval of Benralizumab solution for Injection 30 mg/ml in auto-injector with a waiver of phase III local clinical trial with the condition to conduct the Phase IV clinical trial to generate more data in the Indian population concerning safety, functionality, and reliability of auto-injector.

Accordingly, the expert panel suggested that the firm should submit the Phase IV clinical trial protocol to CDSCO within 3 months of approval for review by the committee.

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Eye health risks during heatwaves

Delhi has been enduring a severe heatwave over the past two weeks, with Mungeshpur in the city’s northwest experiencing temperatures as high as 52.9 degrees Celsius. The extreme heat has led to health concerns, including heatstroke, which resulted in a fatality. Additionally, the intense heat has raised alarms about eye health, specifically the risk of eye stroke.
Eye stroke, or anterior ischemic optic neuropathy, occurs due to insufficient blood flow to the tissues in the front part of the optic nerve, as stated by Penn Medicine. When the blockage happens where blood vessels exit the optic nerve and reach the retina, it’s termed central or branch retinal artery occlusion. This condition can lead to a sudden loss of vision.

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Health Bulletin 01/ June/ 2024

Here are the top health stories for the day:

NMC invites higher education institutes to apply for ODL, online program recognition

Through a recent notice, the National Medical Commission (NMC) has told eligible Higher Educational Institutes (HEIs) to submit applications to the University Grants Commission (UGC) for recognition to offer programmes under Open and Distance Learning (ODL) mode and/or Online modes for the academic year 2024-2025, academic session beginning September 2024 and onwards.

NMC issued the notice on 30.05.2024 after receiving a communication in this regard from the Distance Education Bureau of the University Grants Commission (UGC).
For more information click on the link below:

Patient booked for attacking doctor with iron stand & abusing staffers

In an incidence of violence against medical professionals, a 57-year-old doctor at a private clinic in Vaiduwadi was attacked by a patient with an iron stand over an alleged delay in dressing his wound. In response, the police have booked the patient.

In addition to the doctor being attacked, two female employees at the clinic were also allegedly mistreated by the patient who came to have the wound on his right hand treated. However, he became aggressive towards the staff members when he discovered that the doctor was absent from the clinic.

For more information click on the link below:

Pune Doctor Attacked With Iron Stand For Alleged Delay In Dressing Wound


Hospital and doctor fined Rs 50 Lakh for failing to detect anomaly, leading to baby’s 90% disability

The Kerala State Consumer Disputes Redressal Commission recently directed Malappuram-based hospital and its doctor to pay Rs 50 lakh as compensation to a woman who gave birth to a child with 90% locomotor disability. It was alleged that neither the hospital nor the doctor had even given her any indication regarding the abnormality of the child before delivery despite repeated scans.
While considering the matter, the State Consumer Court had set up a Medical Board, which had opined that the doctor had not exercised reasonable skill while conducting the ultra-sound scan. The Board had opined that if the doctor had exercised reasonable skill, the deformity could have been detected at the scan done when the gestation age was sixteen weeks.
For more information click on the link below:

Outlet selling human breast milk at ₹ 500 for 100 ml sealed in Chennai
In a significant crackdown, the Food Safety and Standards Authority of India (FSSAI) has sealed an outlet in Chennai that was selling human breast milk at ₹ 500 for 100 ml. Following a complaint, the outlet was under surveillance for ten days, culminating in a surprise raid that uncovered a stock of human breast milk. Dr. M Jagadish Chandra Bose, Designated Officer of the Food Safety Department in Tiruvallur, confirmed that bottles labeled as pasteurized human breast milk, including names of donor mothers, were found.
Dr. Bose stated, “We don’t know what procedure they adopted to pasteurise the milk. We will take further action after investigation.” This follows an advisory issued by FSSAI earlier in May, which warned against the commercialization of human milk, stating it is not permitted under the FSS Act 2006.

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Hospital, doctor directed to pay Rs 50 lakh compensation for failure in detecting anomaly during gestation period

The Kerala State Consumer Disputes Redressal Commission recently directed Malappuram-based hospital and its doctor to pay Rs 50 lakh as compensation to a woman who gave birth to a child with 90% locomotor disability. It was alleged that neither the hospital nor the doctor had even given her any indication regarding the abnormality of the child before delivery despite repeated scans.
While considering the matter, the State Consumer Court had set up a Medical Board, which had opined that the doctor had not exercised reasonable skill while conducting the ultra-sound scan. The Board had opined that if the doctor had exercised reasonable skill, the deformity could have been detected at the scan done when the gestation age was sixteen weeks.
For more information click on the link below:

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Delay in dressing his wound: 57-year-old doctor attacked with iron stand

In an incidence of violence against medical professionals, a 57-year-old doctor at a private clinic in Vaiduwadi was attacked by a patient with an iron stand over an alleged delay in dressing his wound. In response, the police have booked the patient.

In addition to the doctor being attacked, two female employees at the clinic were also allegedly mistreated by the patient who came to have the wound on his right hand treated. However, he became aggressive towards the staff members when he discovered that the doctor was absent from the clinic.

For more information, click on the link below:

Pune Doctor Attacked With Iron Stand For Alleged Delay In Dressing Wound

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Apply for recognition to offer programmes under open and distance learning, online modes: NMC tells eligible higher educational institutes

Through a recent notice, the National Medical Commission (NMC) has told eligible Higher Educational Institutes (HEIs) to submit applications to the University Grants Commission (UGC) for recognition to offer programmes under Open and Distance Learning (ODL) mode and/or Online modes for the academic year 2024-2025, academic session beginning September 2024 and onwards.
NMC issued the notice on 30.05.2024 after receiving a communication in this regard from the Distance Education Bureau of the University Grants Commission (UGC).
For more information click on the link below:

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Alleged Delay of 40 minutes in transfer: Patient dies from postpartum haemorrhage at YCM Hospital

Pimpri: After delivering a healthy baby, a 30-year-old woman passed away from postpartum haemorrhage at Yashwantrao Chavan Memorial (YCM) Hospital in Pimpri following a Cesarean section at Pimpri Chinchwad Municipal Corporation’s (PCMC) Jijamata Hospital.   

According to the relatives, the woman was transferred to YCM Hospital based on the recommendation of doctors at Jijamata Hospital as she was bleeding profusely after childbirth. However, they claimed there was a delay of around 40 minutes in transferring her to the YCM Hospital for further medical assistance.

Claiming that the delay in her transfer to the hospital resulted in her death, the family members have claimed that her death was due to medical negligence. However, no complaint has been filed yet in connection with the case and her baby is presently fine after being in the Neonatal Intensive Care Unit (NICU) at Jijamata Hospital.

Also read- Infant Dies Within 36 Hours At Rajkot Civil Hospital, Family Alleges Medical Negligence

As per the Punekar news report, the incident took place on May 22 when the woman underwent a C-section and delivered her baby at Jijamata Hospital. On May 20, the woman visited the hospital for a regular checkup and the doctors advised her to get admitted. Following this, she was admitted to the hospital on May 21. 

After the delivery on the next day, she began bleeding uncontrollably and the doctors referred her to YCM Hospital. She reached the referred hospital about 40 minutes late as alleged by her family members. Unfortunately, she died during the treatment. 

Meanwhile, PCMC’s Medical Officer of Health, Dr Laxman Gophane denied the accusation of late transfer leading to her death and stated that they had performed a hysterectomy but could not be saved as her bleeding did not stop. 

“She had a Cesarean section delivery. Due to excessive post-delivery bleeding, she had to be admitted to YCM Hospital. We performed a hysterectomy as the bleeding wouldn’t stop. Despite our efforts to supply blood to her, the bleeding continued, and she passed away. There was no delay in treatment. The baby is fine and has been handed over to the relatives,” he told The Daily. 

Social activist Avinash Waghmare said, “PCMC spent Rs 40 Crore to build Jijamata Hospital with advanced equipment. Yet, the woman died despite these facilities. Is PCMC going to take responsibility for this? If all the facilities and doctors are there, but the woman still has to be admitted to YCM Hospital, what is the use of spending money and building these hospitals? A thorough investigation should be conducted.”

Also read- Gynaecologist On Phone, Nurses Performing Delivery: Doctor Booked Under IPC 304A After Death Of Newborn

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Mental health, Well-being Woes: What are the Five Issues that Resident Doctors Are Fighting For?

New Delhi: Representatives of the resident doctors recently highlighted their demands before the National Task Force of the National Medical Commission (NMC), which is currently considering the issues affecting the mental health and well-being of medical students including the resident doctors. 

The Task Force, which will submit its recommendations soon, recently held a meeting with the stakeholders including the undergraduate and postgraduate medical students, faculties and the parents of medical students to discuss the issues.

Medical Profession is one of the harshest professions when it comes to the time and effort involved. The period of residency requires the full-time presence of the doctors in the hospital, day-in, day-out toppled with various night duties coming in rotation. Doctors undergoing Junior Residency During the period of Postgraduate medical education complain of long work hours, low pay, almost inhuman working conditions, lack of basic necessities, and even lack of a clear structure of what is expected. 

During the meeting, the representatives of the resident doctors’ associations across the country highlighted the issues and the requirements to make the residency period better for PG medical graduates.

Also Read: Responses Pour in for NMC Task Force Meeting on Mental Well-Being of Medical Students

Here are the five things that the resident doctors in India are currently fighting for:

Leave/Vacation for PG Students: 

One of the major objections and concerns raised by the resident doctors is regarding their inability to avail leave during the period of residency. Due to the huge work pressure in the hospitals where they undergo residency, they fail to avail the leave benefits. The resident doctors allege that because of this, they do not have any work-life balance as they do not get time to spend with their families.

Medical Dialogues had earlier reported that the newly notified Post-Graduate Medical Education Regulations (PGMER) 2023 specified that post-graduate medical students would get a minimum of 20 days of paid leave (casual leave) per year. Apart from this, these new regulations further mentioned that the resident doctors would also be allowed weekly holidays, maternity leave and paternity leaves as per the Government rules and regulations.

While this move was welcomed by the resident doctors as it specified a minimum number of leaves granted to them, due to the immense pressure in the medical institutes, the doctors still complain of being overworked, which ultimately affects their physical and mental health.

Raising this issue, Dr. Prajwal R, a 3rd PG Student and a representative from RDA, PGIMS Rohtak, informed the NMC in its recent meeting about the requirement of granting vacation to the resident doctors. He said that giving vacation to the PG students will allow them to visit their families or do something they like which ultimately helps them mentally.

In his written representation to the NMC National Task Force, he wrote, “Medical students endure tremendous pressure and stress as they juggle academic responsibilities, clinical rotations (including night duties and emergency services), research commitments, and personal obligations. The demanding nature of medical education often leads to burnout, anxiety, and depression among students, impacting their overall well-being and academic performance. It is needless to say to what an asset PG medical student, who work as full-time resident doctor in the institution they are serving and they contribute significantly to the health care system of state across the nation.”

“The initiation of vacation to PG students would go long way in relieving mental health of PG students and allow PG student to spend quality time with family and loved ones who travel long distance for pursuing medical education, additionally enable him to improve the understanding of medicine and it would reflect on overall wellbeing of patient care,” he further mentioned in the letter.

Moreover, in the meeting, the president of the NMC PG Board, Dr. Oza had clarified that 20 days of leave mentioned in the regulations is the minimum number of days of leave that should be granted. However, it can be much more in any specific institute.

Also Read: All PG medical students to work as full-time resident doctors for reasonable working hours: NMC PGMER 2023

Regulation of Duty-Hours: 

Resident doctors in medical colleges often complain of being overworked and sleep-deprived due to long duty hours. Even though there have been efforts in the past to address the long working hours, doctors complain that policy has remained limited to the paper only. The Supreme Court in the 1990s had directed the Central Government to form a Uniform Central Residency Scheme defining base for all functioning of resident doctors.

Consequently, the Central Residency Scheme was introduced in 1992 and it addressed several issues including the number of duty hours done by a resident doctor, the issue of weekly off, accommodation of residents, leave travel concessions, etc. Under this scheme, it was mentioned that the duty hours for the resident doctors would not exceed 12 hours at a time. It had also offered them one weekly holiday by rotation.

However, these resident-friendly rules remained only on paper, and resident doctors are still found doing at least 70-80 hours of duty a week. In case of a high workload, the duty hours can further be extended. The situation is worse for clinical branches, where certain weeks the work hours can even reach 100 hours.

Recently NMC addressed the issue of working hours for the resident doctors and in this regard, the PGMER 2023 mentioned that all post-graduate students will work “reasonable working hours” and they will also get “reasonable time for rest in a day”.

Therefore, no specific duty hours were mentioned by NMC in its regulations. Recently when the NMC National Task Force asked the stakeholders to submit their responses regarding the issues they faced, a doctor referred to the PGMER 2023 as vague and unjustified. Seeking clarity, the doctor from Jharkhand mentioned that apart from hospital duty, the resident doctors also need to do academic work. Therefore, the doctor suggested that the NMC regulations should specify an eight-hour daily duty and a maximum of 48 hours weekly duty. 

Highlighting the issue of unjustified working hours, a first-year ENT resident claimed that in their college, the working hours are excessively long i.e. 14 hours on regular days. She alleged that the duty hours get extended up to 38 hours on duty days and the students do not get off even on Sundays, as they are required to work until noon or later for camps. As per the PG medico, while the NMC guidelines advocate for giving the resident doctors a day off weekly, the rule does not get implemented and those requesting leave face criticism.

“We lack time for eating, sleeping, and health check-ups. Raising concerns is dismissed with the excuse that this is typical for postgraduates, and NMC guidelines are not strictly followed,” said the doctor.

Also Read: 20 days of Paid leave, weekly offs, reasonable working hours for PG medicos: NMC PGMER 2023

Good Health: 

Resident doctors have time and again highlighted that they remain sleep-deprived and do not even get time to eat or undergo health check-ups due to the long duty hours. Apart from this, they are always exposed to possible health hazards as they are the first line of contact with patients suffering from numerous ailments.

Highlighting the requirement of good physical health for the residents, Dr. Aviral Mathur, the president of the Federation of Resident Doctors Association (FORDA) recently mentioned in his written submission to the NMC National Task Force that the resident doctors should be granted Risk Hazard allowance “for damages/ diseases contracted in the line of duty and a provision of a mandatory health service card to them.”

During the NMC meeting, Dr Mathur also urged the authorities to ensure that CGHS/DGHS facilities are also extended to resident doctors.

Also Read: From Ragging to Stipend issues: Here’s what was discussed at NMC Task Force meeting today

Salary/Stipend: 

One of the major issues that the resident doctors face is the inadequate amount of stipend they receive. While the residents in the government medical institutes comparatively get better salaries, the PG medical residents undergoing residency in private medical colleges often complain about not getting a proper stipend. Sometimes they allege that even though they are paid on paper, a huge amount or the full amount is later retracted by the institute.

Medical Dialogues had last year reported about the glaring disparities in the amount of stipend paid to Undergraduate and Postgraduate medical students across the country. As per the data regarding the students admitted through the National Eligibility-cum-Entrance Test Postgraduate (NEET-PG) examination 2022, which is available on the official website of the Commission, there were glaring disparities in the stipend paid to the Junior Resident doctors across the country.

The data revealed that the minimum amount of stipend (Rs 20,000 or less than Rs 20,000 per month) is paid to the resident doctors pursuing their postgraduate medical education in medical colleges located in States like Karnataka, Punjab, Rajasthan, and Uttar Pradesh.

Meanwhile recently releasing the final Post-Graduate Medical Education Regulations, 2023 (PGMER 2023), which were published in the official Gazette on 29.12.2023, the National Medical Commission (NMC) introduced uniformity in the amount of stipend paid to the PG medicos in a particular State/UT.

The Commission specified that the PG medicos who are pursuing degree, diploma or super-speciality courses should be paid a stipend at par with the stipend being paid to the PG students of Government institutes, in that particular State/UT. However, despite the NMC directive, residents from several private medical colleges complain of not getting enough stipend. 

After the Supreme Court took cognisance of the issue of stipend paid to the medical students, NMC recently gave a deadline to the medical colleges to submit the details of the stipend paid to their UG Interns, Post-Graduate Residents, and Senior Residents or PGs in Super Specialty for the financial year 2023-24.

NMC provided a similar annexure for the details of the stipend paid to the medical students for the academic year 2024-2025. Further, in this regard, the Commission had directed the concerned colleges to update these details on the website of the institute every month (by 5th of every month). The colleges had been asked to submit the complete statement to the NMC at the end of each financial year.

Also Read: Uniform Stipend for all PG Medicos in a particular State, UT: NMC

Freedom from Bond: 

Another issue that often troubles the resident doctors is the imposition of bond conditions- both service bond and seat leaving bond. While the seat-leaving bond is imposed on the students to discourage them from discontinuing their medical course and the consequent ‘wastage’ of medical seats, the service bond was introduced to ensure the availability of doctors in rural areas.

Earlier this year, the Apex Medical Regulator NMC had already directed the State/UT governments to reconsider the seat leaving bond conditions for the PG medical students.

The Anti-Ragging Committee of NMC had recommended the State/UT to review the seat-leaving policy in medical colleges in an attempt to address the mental health concerns of PG medical students. Earlier,t as an alternative, NMC had recommended that the States consider debarring the students for admission in their States for the next year.

This issue of the seat-leaving bond was raised during the recent NMC meeting. Dr. Rohan Krishnan, the National Chairman of the Federation of All India Medical Association (FAIMA) pointed out how the issue of the seat-leaving penalty puts pressure on the medical students and opined that there should be a free exit.

Also Read: Breaking News: NMC Asks States to do Away with Seat leaving Bond

Earlier, the Supreme Court had suggested that there should be a uniform security bond amount across the States. The top court bench comprising Chief Justice of India D.Y. Chandrachud, Justice Hima Kohli and Justice J.B. Pardiwala had opined that the students who join the medical courses often come from humble middle-class backgrounds and therefore, there should be uniformity regarding the bond amount for vacating the seats.

Regarding the imposition of service bonds, Dr. Aviral Mathur mentioned in the NMC National Task Force’s meeting that during the District Residency, the doctors are catering to the district hospitals. Therefore, he pointed out that DRP is substituting the bond service to some extent and suggested that considering this fact, the tenure of the bond service should be reduced.

In a written representation to the Task Force, Dr Mathur highlighted the requirement of “Formation of an Indian Medical Services cadre, who will better understand & be solely responsible for the bureaucratic and administrative decisions and redressal of complaints BOND FREE MEDICAL EDUCATION- A pertinent issue which has been the cause of contention and protests in many states recently. There should be a uniform policy decision on the same.”

Meanwhile, in the meeting, NMC Secretary Dr. Srinivas clarified that NMC is not in favour of bonds. However, pointing out that this is a State issue, he mentioned that NMC cannot enforce it. He also added that NMC recommended to the Ministry that the bond should be removed.

Also Read: NMC considering to relax bond policies: Report

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