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A medical mess

Post-graduate professors are already overburdened and the simultaneous running of two batches, under the circumstances, is far from practical. Deprivation of medical care to patients in a situation exacerbated by the threat of Omicron, a possible brain-drain and the financial loss to the nation cannot be measured in monetary terms

DEVENDER SINGH ASWAL | New Delhi |

Peaceful bandhs, gheraos and protests are quintessential features of democracy for which India is acclaimed globally. After prolonged protests over the Citizenship (Amendment) Act and the three farm laws, India has again caught the attention of global media with thousands of striking resident doctors of New Delhi-based government hospitals faced off with the police over the unconscionable delay in NEET-PG 2021 counseling. Further delay may lead to paralysis of medical services across the country as the Federation of All India Medical Association (FAIMA) has threatened to boycott all work including emergency services as a mark of protest against crackdown on the resident doctors.

The alleged assault on the doctors and registration of FIRs against them is deeply distressing as they were showered with rose petals by the Government a year back for being corona warriors. The resident doctors have been protesting since November 27 against the multiple postponements of the NEET PG Counselling 2021 and the subsequent admission of a fresh batch of resident doctors in medical colleges.

Resident doctors are crucial for the entire healthcare system including Covid care. A public health expert has aptly said that nothing is truer in the medical profession than this ~ ‘Interdependence is a higher value than independence’. NEET-PG-21 counselling can’t brook delay for a variety of interdependent, interconnected and ancillary reasons. It would be worthwhile to go into the genesis of the current agitation.

On 29 July 2021, the Union government issued a notification introducing two new reservations for undergraduate and postgraduate medical and dental courses, beginning from the current academic year 2021-22. Under the notification, 10 per cent are reserved for economically weaker section (EWS) and 27 per cent for the Other Backward Classes (OBC) under All India Quota (AIQ). The National Testing Agency (NTA), Ministry of Education, conducts the National Eligibility-cum-Entrance Test (NEETUG) that is the examination for entry to all undergraduate (NEETUG) courses.

The National Board of Examination (NBE), Ministry of Health and Welfare, conducts the NEETPG, that is the Post Graduate examination for medical and dental courses in the country. The NEET-PG exam was supposed to be held in January 2021. But it was postponed to April 2021 and owing to the evolving Covid-19 situation, further postponed to September 2021. The NEET-PG exam result came out the following month.

The counseling was to start from the end of October itself. But the counselling to PG courses could not start as the notification regarding reservations for the OBCs and the EWS was challenged in the Supreme Court by some doctors aspiring to earn a post-graduate degree. The petitioners also challenged the reasonableness of the annual income ceiling of Rs 8 lakh fixed by the government to determine EWS status.

The matter was heard by the Supreme Court on 25 November 2021. On being asked about the rationale of the income ceiling of Rs 8 lakh, the learned Solicitor-General, Tushar Mehta, told the Supreme Court that reservation being a matter of social justice, it could not be postponed and sought four weeks’ time for reviewing the criteria of Rs 8 lakh annual income for EWS candidates. He also stated that the review process would take about four weeks, and that till this time PG Counselling would be kept on hold.

The government has constituted a three-member committee to revisit the EWS criteria with a direction to submit a report within four weeks. The next hearing is slated for 6 January 2022. However, as a fallout of clashes with police and registration of FIRs against some protesting doctors, the resident doctors have called for total shutdown of medical services in Delhi hospitals.

Terming it a ‘black day’ in the history of the medical fraternity, the Federation of Resident Doctors’ Association (FORDA) said there will be a complete shutdown of all healthcare institutions. In a Press Release, FORDA said, “we strongly condemn this brutal act & demand immediate release of all Resident Doctors. There will be complete Shutdown of Healthcare Institutions…” They also urged all State RDAs to join the agitation. FAIMA has shown solidarity with them. The resident doctors have been insisting that the Health Ministry give a written assurance that counselling will be started by a specific date. As the matter is sub-judice, the ministry is in a dilemma. Moreover, the next hearing date is close.

It may be recalled that the All India Quota (AIQ) scheme was introduced in 1986 under the Supreme Court’s directions to provide for domicile-free meritbased opportunities to students from any state aspiring to study in a good medical college in any of the states. The AIQ consists of 15 per cent of the total available UG seats and 50 per cent of the total available PG seats in government medical colleges. Notably, prior to 2007, there was no reservation in the AIQ scheme. In 2007, the Supreme Court introduced 15 per cent reservation for the Scheduled Castes (SCs) and a 7.5-per cent quota for the Scheduled Tribes (STs) in the AIQ scheme.

When the Central Educational Institutions (Reservation in Admission) Act came into force in 2007, it provided for the first time 27 per cent reservation to the OBCs. It was implemented by all central medical educational institutions such as the Safdarjung Hospital, the Lady Hardinge Medical College, Aligarh Muslim University and Banaras Hindu University. However, it was not extended to the AIQ seats of the state medical and dental colleges.

The 103rd Constitutional Amendment in 2019, provided for 10 per cent reservation for the EWS category in all central educational institutions. The number of seats in medical and dental colleges was increased over the next two years (2019-20 and 2020-21) to accommodate this additional 10 per cent EWS reservation so that the total number of seats available for the unreserved category was not reduced.

In the AIQ seats, however, these benefits were not extended. On a petition filed by the DMK party, the Madras High Court ruled in 2020 that OBCs were entitled to reservations in the AIQ seats and directed the Union Government to implement the same from the academic year 2021. The Union Government, after careful consideration, took a conscious policy decision and decided to provide 27 per cent reservation for OBCs and 10 per cent reservation for EWS in theAIQ seats for all undergraduate and postgraduate medical/dental courses from the current academic year, 2021-22.

Given the enormous delay in holding NEET-PG-21 Counselling, the government could have taken a decision to implement these reservations from the next academic year 2022-23. But no democratic government which must seek popular support can be seen dithering and prevaricating on the highly emotive and inflammable issue of social justice, more so when elections are round the corner.

The forgotten Mandal Commission recommendations were sought to be implemented by VP Singh as a counter measure to save his government. The Narasimha Rao Government had introduced 10 per cent reservation for the EWS apart from 27 per cent reservations for the OBCs which were challenged before the Supreme Court in 1992. The apex court in the famous Indra Sawhney vs Union of India case upheld 27 per cent quota for the OBCs but struck down 10 per cent reservation for the EWS. However, with the passage of the 103rd Constitution Amendment, the reservation for the EWS has been constitutionally guaranteed.

The resident doctors want NEET-PG-21 Counseling to start without further loss of time, which has been delayed unconscionably and inordinately for multiple reasons including the outbreak of Covid-19, and the decision to introduce reservations for the OBCs and the EWS. The 2022-23 academic session is only a few months away and given the severe constraints of infrastructure and faculty, approximately 90,000 PG students cannot be catered by a system meant for 45,000 students per academic year.

Besides great mental agony and affliction to the students, it will have a severe and debilitating effect on teaching and patient-treatment. To overcome the shortage of teachers, the Medical Council of India (now Medical Commission) increased the professor-teacher ratio from 1:2 to 1:3 from the academic session 2018-19. The PG professors are already overburdened and the simultaneous running of two batches, under the circumstances, is far from practical.

Further, deprivation of much needed medical care to patients exacerbated by the looming threat of Omicron, possible brain-drain and the financial loss to the nation cannot be measured in monetary terms. Indian medical education is acclaimed worldwide. Indian doctors and paramedical staff are widely regarded for their professionalism. The entire nation looks with great hope and expectation to the apex court to resolve the matter for we can ill-afford prolonged protests by our doctors.

(The writer is ex Additional Secretary, Lok Sabha and a member of the Delhi Bar Council. Views expressed are personal)