I am quite sure many of you must have seen advertisements in newspapers, medical journals and other medicine related publications offering certificate and diploma courses in various medical subjects, for example diabetology and ultrasonography. Almost all of these courses are conducted by private institutions without any recognition from the Medical Council of India (MCI) and the central government. All such courses are unauthorized and hence ill-legal. Still, hoards of medical students and practising doctors fall prey to such advertisements. The urge to add frills to the skirt of our recognized degree is so overwhelming that it precludes any intervention by common sense.
As a radiologist, I am specifically interested in the issue of legality of ultrasound courses being conducted by private institutions and even doctors. Here are some of the reasons as to why such courses are ill-legal and how they can be stopped.
1) The Madras High Court verdicts –
• In 2008, the Madras High Court quashed a State government order (GO) which had allowed a certificate course in Diabetology without the prior permission of MCI. The judges reasoned that the executive power of every State should be exercised ensuring compliance with the laws made by Parliament and any existing law applied in that State. Therefore, the GO was ruled unconstitutional and preventable in view of Entry 66 of List I of the constitution. The judges clearly stated that no course in medical education by any name could be started without the permission of MCI and the Central government.
• In 2011, the Madras High Court declared 11 post-graduate diploma courses conducted by Tamil Nadu Dr MGR University as illegal since they were being conducted without the prior approval of MCI or the Central government. Justice N Paul Vasantkumar said: “The university is not empowered to grant permission to any institution or medical college to conduct any PG diploma course in medical sciences without prior approval of the central government as required under section 10A(1) of the Medical Council of India Act, 1956.” The judge also pointed out that according to the MCI Ethics Code Regulations (2002), a physician is supposed to suffix only recognized qualifications. The honourable judge said that “Without such recognition, if any person is allowed to suffix PG diploma in medical sciences along with MBBS degree, the general public will definitely get an impression that the physician is a specialist. Special status can be claimed by any physician only after getting an approved PG diploma and not half-baked diploma courses offered by the university.”
• The above two verdicts make it amply clear that no course in the field of medicine can be conducted without the approval of the Medical Council of India and the Central government. But still ill-legal courses in medicine continue to be conducted in India. Why? Because nobody bothers to challenge them in the court of law. Though suo motu action is possible, medical councils hardly have the inclination or time.
2) The observations of Delhi High Court –
While deciding on two writ petitions — W.P.(C) 6654/2007 and W.P.(C) 6826/2007 — both of which concerned the ambiguity surrounding the definition of a sonologist, the Delhi High Court made the following comments in the year 2010 –
“As a result of the weak definition of the term sonologist” under the PNDT Act, the mushrooming growth of diagnostic clinics is unable to be effectively regulated. The absence of clear rules and guidelines spelling out unambiguously the qualification, training and experience required for operating a diagnostic clinic offering ultrasound tests has resulted in unethical practices being adopted in many such clinics in violation of the PNDT Act going unchecked. These cases underscore the need to amend the PNDT Act to plug the loopholes and reflect the view of the MCI as indicated in its reply dated 4th May 2009 to one of the Petitioners where it suggested that person seeking to run a diagnostic clinic should either possess a post-graduate degree in Radiodiagnosis or should be a specialist who has undergone orientation training in ultrasonography in a recognized medical institution for a minimum period of six months.”
3) The MCI guidelines –
In the meeting held on 26.12.2011 the Board of Governors of Medical Council of India addressed the following issues at the behest of the Delhi High Court:
1. The requirements in terms of qualification, training and experience required to be registered as a “sonologist” to be specified so as to be incorporated in the Pre-conception and Pre-natal Diagnostic Techniques (PCPNDT) Act.
2. The state-wise names of the institutions recognized for the purpose of ultrasound training.
3. Deciding upon the time-frame for prospective implementation of the changed criteria for the purpose of registration or renewal of registration under the PCPNDT act.
As far as the definition of a “sonologist” given by the MCI is concerned, it is a matter of separate debate, especially because the MCI considers gynaecologists as default sonologists without the need for any sort of dedicated training in ultrasound! That issue, however, is outside the scope of this article.
The current topic of discussion warrants attention to the following important decisions taken by the MCI in this meeting as regards ultrasound training for non-radiologist / non-gynaecologist doctors –
• The centres for ultrasound training shall be government recognized teaching institutions.
• Any training centre not recognized and not duly notified by the respective state government will be considered as flouting the PCPNDT Act and appropriate action, (as per the provisions of the PCPNDT Act) will be initiated against the doctors/persons running such non-recognized centres.
In other words, no private institution or doctor can conduct ultrasound training courses with the aim to provide certification of competence. Some private institutions conducting unauthorized ultrasound courses even claim of being recognized by Indian Medical Association (IMA) and Federation of Obstetrics and Gynaecological Societies of India (FOGSI) for the purpose of ultrasound training. IMA and FOGSI are non-governmental medical associations. No medical association has a legal authority to certify practice competence of doctors. Only MCI has the authority to lay down the criteria for doctors’ training and qualification, and that too in accordance with the Indian Medical Council Act (IMC Act), 1956.
Doctors need to realize that there are no shortcuts to a medical qualification. Doctors’ persistent greed for adding more and more clusters of alphabets to their medical titles primarily feeds the mushrooming business of unauthorized courses in medicine. While they rightfully oppose the practice of allopathy by non-allopathic doctors, allopathic doctors conveniently turn a blind eye towards the malpractice of unauthorized courses in modern medicine. It is the duty of medical associations to take such malpractices to their legal conclusion. Medical associations should not allow their names to be annexed to such malpractices. Court of law is the ultimate way to seek justice. Courts can help, but only when an illegality is officially brought to its notice. So doctors, here is an opportunity for redemption.
Dr Chandrashekhar Sohoni
Medcliniq Health Centre, Karve Road, Pune
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