Section 13(4A) does not apply at a stage where the person who is already enrolled on the State Medical Register obtains an additional qualification in terms of a postgraduate degree from an institution abroad.

The Indian Medical Council Act, 1956

1.   The Preamble to the Act suggests that the Act is enacted to provide for the reconstitution of the Medical Council of India and the maintenance of a medical register for India and for matters connected therewith. Section 2 defines certain terms and states that "Council" means the Medical Council of India constituted under the Act. Medical institution is defined to mean any institution, within or without India, which grants degrees, diplomas or licences of medicine, whereas the term "recognized medical qualification" means any of the medical qualifications included in the Schedules. Section 3 provides for constitution and composition of the Council whereas Section 7 deals with term of office of President, Vice- President and members of the Council and Section 9 provides for officers, Committees and servants of the Council.

2.   Section 10A, brought on the Statute Book by Act 31 of 1993 with effect from August 27, 1992, deals with permission for establishment of new medical college, new course of study. Sub-Section (1) of Section 10A begins with non-obstante clause and provides that notwithstanding anything contained in this Act or any other law for the time being in force, no person shall establish a medical college nor any medical college shall open a new or higher course of study or training or increase its admission capacity in any course of study or training, except with the previous permission of the Central Government obtained in accordance with the provisions of the said Section. Explanation 1 to Section 10A(1) explains as to what is meant by the word `person' whereas Explanation 2 mentions as to what is meant by the words `admission capacity'. Sub-Section 2 inter alia stipulates that in order to obtain permission of the Central Government, the person desirous of establishing a medical college or a medical college desirous of opening a new or higher course of study or training or increasing its admission capacity has to submit a scheme to the Central Government and the Central Government has to forward the scheme to the Council for its recommendations. Sub-Section (3), amongst other things, provides for manner in which the scheme forwarded to it has to be evaluated by the Council and Clause (b) mandates that the Council has to consider the scheme having regard to the factors referred to in sub-Section (7) of Section 10A. A glance at sub-Section (7) of Section 10A makes it clear that the intention of the legislature in providing the factors is to see that a medical student acquires proficiency in the science of treatment of human beings and is not found wanting in any way. Section 10B of the Act provides the consequences that would follow in case a medical college is established without previous permission of the Central Government or when any medical college opens a new or higher course of study or training and inter alia provides that when any medical college increases its admission capacity in any course or training without previous permission of the Central Government, no medical qualification granted to any student of such medical college on the basis of the increase in its admission capacity shall be a recognized medical qualification for the purposes of the Act.

3.   Recognition of medical qualification by Universities or medical institutions in India is provided by Section 11. It is mentioned in sub-section 1 of the said Section that the medical qualifications granted by any university or medical institution in India which are included in the First Schedule shall be recognized medical qualifications for the purposes of the Act. Sub-Section (2) empowers the Central Government to amend the First Schedule, when an application is made either by the University or medical institution in India so as to include the medical qualification not included in the First Schedule but is granted either by the University or the medical institution. Thus the First Schedule is not exhaustive and can be amended by the Central Government subject to the conditions mentioned in sub-section (2) of Section 11 of the Act. Even if the amendment is made in the First Schedule, Section 11 does not exhaust the scheme of recognition of medical qualifications granted by the Universities or medical institutions in India. It was noticed that no provision was made in Section 11 of the Act regarding recognition of medical qualifications granted by several medical institutions which are not included in the First Schedule. Further it was also necessary to recognize the medical qualifications granted to a citizen of India before August 15, 1947 by medical institutions in the territories now forming part of Pakistan and before April 1, 1937, by medical institutions in the territories now forming part of Burma. Therefore, the Legislature has enacted Section 13(1) and provided in the said sub-Section that the medical qualifications granted by medical institutions in India which are not included in the First Schedule and which are included in Part I of the Third Schedule shall also be recognized qualifications for the purposes of the Act. Sub-Section (2) of Section 13 lays down that the medical qualifications granted to a citizen of India (a) before August 15, 1947 by the medical institutions in the territories now forming part of Pakistan and (b) before April 1, 1937 by medical institutions in the territories now forming part of Burma which are included in Part I of the Third Schedule shall also be recognized medical qualifications for the purposes of the Act. The scheme envisaged for recognition of medical qualifications granted by Universities or medical institutions in India is such that Section 11 of the Act cannot be read in isolation, because the said Section does not offer a complete scheme relating to recognition of medical qualifications granted in India. In order to make the scheme complete, one has got to read the provisions of Section 11 with the provisions of sub-Sections (1), (2) and (5) of Section 13 of the Act. Section 11, First Schedule, sub-Sections (1), (2) and (5) of Section 13 and Part I of the Third Schedule constitute a complete code relating to the scheme of recognition of medical qualifications granted by Universities or medical institutions in India.

4.   Similarly, recognition of medical qualifications granted by medical institutions in countries with which there is a scheme of reciprocity is dealt with by Section 12 of the Act. Sub-Section (1) of Section 12 of the Act provides that the medical qualifications granted by medical institutions outside India which are not included in the Second Schedule will be recognized medical qualifications for the purposes of the Act. Sub- Section (2) of the said Section inter alia lays down that the Council may enter into negotiation with the Competent Authority in any country outside India to settle a scheme of reciprocity and on the basis of such a scheme, the Central Government may amend the Second Schedule so as to include therein the medical qualifications which the Council has decided, should be recognized and it may also direct that an entry shall be made in the last column of the Second Schedule against such medical qualification, declaring that it shall be a recognized medical qualification only when granted after a specified date. Sub-Section (3) of Section 12 deals with the powers of the Central Government to amend the Second Schedule and give direction that an entry be made therein in respect of any medical qualification declaring that it shall be a recognized medical qualification only when granted before a specified date. Sub-Section (4) deals with a situation where the Council has refused to recommend any medical qualification which has been proposed for recognition by any Authority referred to in sub-Section (2) of Section 12 of the Act and provides that in such a situation the Authority would be entitled to apply to the Central Government and the Central Government may, after considering the application of the Authority and obtaining a report, if any, from the Council as to the reasons for any such refusal, by notification, amend the Second Schedule so as to include such qualification therein and the provisions of sub-Section (2), shall apply to such notification. As noticed earlier, Section 13 also makes provisions for recognition of medical qualifications granted by certain medical institutions outside India whose qualifications are not included in the Second Schedule. While examining the scope of Section 11 of the Act, the Court has already taken into account the sweep and ambit of sub-Sections (1) and (2) of Section 13 of the Act. Therefore, it would be relevant to examine the scope of sub-Section (3) of Section 13 of the Act. The said sub-Section lays down that the medical qualifications granted by medical institutions outside India (before such date as the Central Government may, by notification in the Official Gazette specify) which are included in Part II of the Third Schedule shall also be recognized medical qualifications for the purposes of the Act. However, the said sub- Section itself carves out an exception that no person possessing any such qualification shall be entitled to enrolment on any State Medical Register unless he is a citizen of India and has undergone such practical training after obtaining that qualification as may be required by the rules or regulations in force in the country granting the qualification or if he has not undergone any practical training in that country, he has undergone such practical training as may be prescribed. It is an admitted position that the date specified by the Central Government under Section 13(3) in the Official Gazette is March 15, 2002. It means that the medical qualifications granted by medical institutions outside India before March 15, 2002, which are included in Part II of the Third Schedule, shall be recognized medical qualifications but no person possessing any such qualification shall be entitled to enrolment on any State Medical Register if he is not a citizen of India and has not undergone practical training after obtaining that qualification as may be required by the rules or regulations in force in that country or if has not undergone practical training prescribed under the Act or rules or regulations. Sub-Section (4) inter alia states that the Central Government may amend Part II of the Third Schedule so as to include therein any qualification granted by a medical institution outside India which is not included in the Second Schedule subject to the limitations and exceptions made in the two provisos to the said sub-section. The first proviso which is brought into force with effect from September 3, 2001, stipulates that after September 3, 2001 no such amendment shall be made in Part II of the Third Schedule to include any primary medical qualification granted by any medical institution outside India. The second proviso further lays down that nothing contained in the first proviso shall apply to inclusion in Part II of the Third Schedule any "primary medical qualification" which expression is explained to be any minimum qualification sufficient for enrolment on any State Medical Register or for entering the name in the Indian Medical Register, granted by any medical institution outside India, to any person whose name is entered in the Indian medical Register.

5.   A fair reading of the provisions of Section 12 with those of Section 13, makes it evident that the scheme of recognition of medical qualifications granted by medical institutions outside India as envisaged by Section 12 is not complete. In order to make the scheme complete, exhaustive and workable, one has to take into account the provisions of sub-Sections (3) and (4) of Section 13 of the Act. The scheme relating to recognition of medical qualifications granted by medical institutions outside India becomes workable only if the provisions of Section 12 of the Act and the contents of Second Schedule are considered with the provisions of sub-Sections (3) and (4) of Section 13 and Part II of the Third Schedule.

6.   Then comes the provisions of sub-Sections (4A), (4B) and (4C) of Section 13 which fall for consideration of this Court. It may be mentioned that sub-Sections (4A), (4B) and (4C) have been brought on the statute book by Act 34 of 2001 which has come into force with effect from September 3, 2001. Those provisions read as under: -

"(4A) A person who is a citizen of India and obtains medical qualification granted by any medical institution in any country outside India recognized for enrolment as medical practitioner in that country after such date as may be specified by the Central Government under sub-Section (3), shall not be entitled to be enrolled on any Medical Register maintained by a State Medical Council or to have his name entered in the Indian Medical Register unless he qualifies the screening test in India prescribed for such purpose and such foreign medical qualification after such person qualifies the said screening test shall be deemed to be the recognized medical qualification for the purposes of this Act for that person.

(4B) A person who is a citizen of India shall not, after such date as may be specified by the Central Government under sub-section (3), be eligible to get admission to obtain medical qualification granted by any medical institution in any foreign country without obtaining an eligibility certificate issued to him by the Council and in case any such person obtains such qualification without obtaining such eligibility certificate, he shall not be eligible to appear in the screening test referred to in sub-section (4A):

Provided that an Indian citizen who has acquired the medical qualification from foreign medical institution or has obtained admission in foreign medical institution before the commencement of the Indian Medical Council (Amendment) Act, 2001 shall not be required to obtain eligibility certificate under this sub-section but, if he is qualified for admission to any medical course for recognized medical qualification in any medical institution in India, he shall be required to qualify only the screening test prescribed for enrolment on any State Medical Register or for entering his name in the Indian Medical Register.

(4C) Nothing contained in sub-sections (4A) and (4B) shall apply to the medical qualifications referred to in section 14 for the purposes of that section."

7.   Sub-Section (4A) provides that a person who is a citizen of India and obtains medical qualification granted by any medical institution in any country outside India recognized for enrolment as medical practitioner in that country after the date to be specified by the Central Government, shall not be entitled to be enrolled on any Medical Register maintained by a State Medical Council or to have his name entered in the Indian Medical Council, unless he qualifies the screening test in India, prescribed for the purpose and such foreign medical qualification shall be deemed to be recognized medical qualification for the purposes of the Act for that person only after such person qualifies the said screening test. Sub-Section (4B) mentions that a person, who is citizen of India, shall not, after the date to be specified by the Central Government, be eligible to get admission to obtain medical qualification granted by any medical institution in any foreign country unless he obtains an eligibility certificate to be issued by the Council. It further provides that in case such person obtains such qualification without obtaining such eligibility certificate, he will not be eligible to appear in the screening test referred to in sub-Section (4A). The proviso to sub-Section (4B) enacts a rule that an Indian citizen, who has acquired the medical qualification from foreign medical institution or has obtained admission in a foreign medical institution before the commencement of the Indian Medical Council (Amendment) Act, 2001, will not be required to obtain eligibility certificate but if he is qualified to any medical course for recognized medical qualification in any medical institution in India, he will have to qualify the screening test for enrolment on any State Medical Register or for entering his name in the Indian Medical Register. Sub-Section (4C) provides that nothing contained in sub-Sections (4A) and (4B) shall apply to the medical qualifications referred to in Section 14 for the purposes of that Section. Sub-Section (5) of Section 13 mentions that any medical institution in India, which is desirous of getting a medical qualification granted by it, included in Part I of the Third Schedule, may apply to the Central Government to have such qualification recognized. It further provides that the Central Government, after consulting the Council, may, by notification, amend Part I of the Third Schedule so as to include such qualification therein. It also provides that the notification may direct that an entry shall be made in the last column of Part I of the Third Schedule against such medical qualification declaring that it shall be recognized medical qualification only when granted after a specified date.

8.   Section 14 of the Act lays down special provisions in certain cases for recognition of medical qualification granted by medical institutions in countries with which there is no scheme of reciprocity. Sub-Section (1) of Section 14 inter alia provides that after consultation with the Council, the Central Government may, by notification, direct that medical qualification granted by medical institutions in any country outside India in respect of which a scheme of reciprocity for the recognition of medical qualifications is not in force, shall be recognized medical qualifications for the purposes of the Act or shall be so only when granted after a specified date. However, the proviso makes it very clear that medical practice by the persons who possess such qualifications shall be permitted only if such persons are enrolled as medical practitioners for the time being in force in that country and would be limited to the institution which they are attached for the time being in force for the purposes of teaching, research or charitable work and would also be limited to the period specified to in this behalf by the Central Government, by general or special order. Sub-Section (2) of Section 14 stipulates that in respect of any such medical qualification, the Central Government, after consulting the Council, may, by notification, direct that it shall be recognized medical qualification only when granted before a specified date.

14. Special provision in certain cases for recognition of medical qualifications granted by medical institutions in countries with which there is no scheme of reciprocity.—

(1) The Central Government after consultation with the Council may, by notification in the Official Gazette, direct that medical qualifications granted by medical institutions in any 1[***] country outside India in respect of which a scheme of reciprocity for the recognition of medical qualifications is not in force, shall be recognised medical qualifications for the purposes of this Act or shall be so only when granted after a specified date: 2[Provided that medical practice by persons possessing such qualifications—

(a) shall be permitted only if such persons are enrolled as medical practitioners in accordance with the law regulating the registration of medical practitioners for the time being in force in that country;

(b) shall be limited to the institution to which they are attached for the time being for the purposes of teaching, research or charitable work; and

(c) shall be limited to the period specified in this behalf by the Central Government by general or special order.]

(2) In respect of any such medical qualification, the Central Government, after consultation with the Council, may, by notification in the Official Gazette, direct that it shall be a recognised medical qualification only when granted before a specified date.

9.   A conjoint and purposeful reading of the different provisions of the Act makes it sufficiently clear that Section 14 is an exception to Section 12, which deals with recognition of medical qualifications granted by medical institutions in countries with which there is a scheme of reciprocity.

10.                Section 15 of the Act refers to the right of a person possessing qualifications in the Schedules to be enrolled. Sub-Section (1) mentions that subject to the other provisions contained in the Act, the medical qualifications included in the Schedules shall be sufficient qualification for enrolment on any State Medical Register. Sub-Section (2) further provides that, save as provided in Section 25, no person other than a medical practitioner enrolled on a State Medical Register, shall practice medicine in any State or hold office as physician or surgeon etc., whereas sub-Section (3) provides for punishment for contravention of any of the provisions of sub-Section (2) of Section 15 of the Act.

11.                The contention that sub-Sections (4A) and (4B) of Section 13 are residual provisions to which Section 14 of the Act, making a special provision in Certain cases for recognition of medical qualifications granted by medical institutions in countries with which there is no scheme of reciprocity, is an exception or the plea that Sections 13(4A) and 13(4B) cannot be applied to Section 12 of the Act, which is a self contained code but may apply to Part II of the Third Schedule, which includes those institutions with which there is no scheme of reciprocity, cannot be accepted.

12.                It is relevant to notice that sub-Sections (4A), (4B) and (4C) of Section 13 of the Act were brought on the Statute book by Act 34 of 2001, with effect from September 3, 2001. On analysis of sub-Section (4A) it becomes sufficiently clear that it would apply when three conditions are satisfied, namely, (i) when a citizen of India obtains medical qualification granted by any medical institution in any country outside India, (ii) the medical qualification obtained must have been recognized for enrolment as medical practitioner in that country and (iii) the medical qualification must have been obtained after the date to be specified by the Central Government. The phrase "medical qualification granted by any medical institution in any country outside India" employed in sub-Section (4A) of Section 13 of the Act is not restrictive in its application at all and takes within its sweep the medical qualifications granted by any medical institution in any country outside India with which a scheme of reciprocity for the purpose of recognition of medical qualification is in force as well as the cases covered by sub-Sections (3) and (4) of Section 13 of the Act. What is relevant to notice isthat Section 11 of the Act refers to the First Schedule whereas Section 12 refers to the Second Schedule and Sections 13(1) and 13(2) refer to Part I of the Third Schedule and Sections 13(3)and 13(4) refer to Part II of the Third Schedule. However, sub-Sections (4A) and (4B) of Section 13 do not refer to any Schedule at all because by those sub-Sections general provisions are enacted which apply to all the cases where a citizen of India has obtained or is desirous of obtaining medical qualification granted by any medical institution in any country outside India. The provisions of sub-Sections (4A) and (4B) would have applied to the cases covered by Section 14 of the Act also but for sub-Section (4C) of Section.

13.                Sub-Section (4C) of Section 13 specifically provides that nothing contained in sub-Sections (4A) and (4B) shall apply to the medical qualifications referred to in Section 14 for the purposes of that Section. If the Legislature was so minded, nothing prevented it from laying down in Section 13(4C) that the provisions of sub-Sections (4A) and (4B) would also not apply to the cases covered by Section 12 of the Act. If the arguments of the learned counsel for the appellants are accepted, the Court will have to re-write sub-Section (4C) by laying down that the provisions of sub-Sections (4A) and (4B) would also not apply to the cases covered by Section 12 of the Act. Such a course is neither permissible nor warranted by the facts of the case.

14.                Even if the material words of Section 13(4A) are capable of bearing two constructions, the most firmly established rule for construction of such words is the rule of "purposive construction or mischief rule". This rule enables consideration of four matters in construing an Act - (1) what was the law before the making of the Act, (2) what was the mischief or defect for which the law did not provide, (3) what is remedy that the Act has provided and (4) what is the reason of the remedy. The rule then directs that the courts must adopt that construction which suppresses the mischief and advances the remedy. Applying this principle of construction to sub-Section (4A) of Section 13 of the Act, the Apex Court finds that the law before the enactment of the said sub-Section was that medical qualifications granted by medical institutions in countries with which there was a scheme of reciprocity included in the Second Schedule, were recognized qualifications for the purposes of the Act. This law continues to be in force even after the enactment of sub-Section (4A). However, over a period of time, it had come to the notice of the Legislature that a large number of private agencies sponsored students for medical studies in institutions outside India for commercial consideration. It was noticed that such students also included those students, who did not fulfill the minimum eligibility requirements for admission to medical courses in India. Serious aberrations were noticed in the standard of medical education in some of the foreign countries, which were not on par with the standards of medical education available in India. These were the defects and/or mischiefs noticed for which no provision was made either in Section 12 or sub-Sections (3) and (4) of Section 13 of the Act. In the year 1956, when the Indian Medical Council Act was enacted, it must not have been contemplated by any one that a large number of private agencies would sponsor students for medical studies in institutions outside India for commercial considerations including those students who were not fulfilling the minimum eligibility requirements for admission to medical courses in India, etc. It was, therefore, felt necessary by Parliament to make a provision to enable the Council to conduct a screening test. This is the remedy that sub-Section (4A) has provided. This remedy is prescribed to satisfy the MCI with regard to the adequacy of knowledge and skills acquired by citizens of India, who obtain medical qualifications from Universities or medical institutions outside India and to ensure that those students have secured the standards of medical education in the foreign countries, which are at par with standards of medical education in India. The remedies mentioned in Sections 13 (4A) and 13 (4B) are prescribed because citizens of India, who have obtained medical qualifications from Universities or medical institutions outside India, would be entitled to practice medicine in India and they cannot be permitted to treat other citizens of India with their half-baked knowledge and jeopardize their precious lives. Thus by adopting rule of purposive construction or mischief rule, it will have to be held that the provisions of sub-Section (4A) of Section 13 of the Act would also apply to the cases covered by Section 12 of the Act.

15.                The MCI has admittedly understood and applied the provisions of the Act by releasing press note to mean that the screening test would not be necessary for students who have obtained degree from foreign medical institutions recognised under Section 12 of the Act and, therefore, MCI is precluded in insisting that the students, who have obtained degrees from foreign medical institutions, is devoid of merit. It is true that at one stage the MCI had released a press note clarifying for the information of general public that eligibility requirements for taking admission in an undergraduate medical course mentioned in Foreign Medical Institutions Regulations, 2002 and the Screening Test Regulation, 2002 would not be applicable to the students joining an undergraduate medical course in foreign countries, recognised and included in the Second Schedule under Section 12 of the Act. However, this was the understanding of MCI, which is one of the parties before the Court. The scope of Section 13(4A) is quite clear and covers all foreign medical institutions falling within the ambit of Sections 12 and 13 of the Act. On a close and careful reading, provisions of the Amending Act of 2001 with the Eligibility Requirement Regulations and Screening Test Regulation, both of 2002, it becomes at once clear that the MCI is obliged to stipulate the screening test in the case of all those candidates, who obtained medical qualification from medical institutions outside India filling within the purview of Sections 12 and 13 of the Act in view of the statutory provisions of Section 13(4A) of the Act. The press release cannot be interpreted as precluding MCI from canvassing correct import of the provisions of the Act. In any view of the matter, the Court is of the firm opinion that press release by MCI cannot preclude the court from placing correct interpretation of the Act.

16.                The recognition of medical qualifications granted by certain medical institutions whose qualifications are not included in the I or II Schedule is dealt with in Section 13 of the said Act. The Indian Medical Council (Amendment) Act, 2001, incorporated certain amendments in Section 13 of the said Act whereby a provision was made for a screening test in India in respect of persons who are citizens of India and obtained medical qualifications granted by any medical institution in any country outside India recognized for enrollment as medical practitioner in that country after such date as may be notified by the Central Government. These amendments incorporated by way of Sub-Sections 4A & 4B of Section 13 of the said Act are, however, not applicable to medical qualifications referred to in Section 14 of the said Act in view of the provisions of Sub-Section 4C of Section 13 of the said Act. Section 14 of the said Act stipulates that the Central Government may issue a notification in the Official Gazette after consultation with the MCI in terms whereof the medical qualifications granted by medical institutions in any country outside India in respect of which a scheme of reciprocity of medical qualifications is not in force, shall be recognized medical qualifications for the purposes of the said Act.

17.              These provisions indicate that sub-section (4A) applies at the stage where the person who obtains a medical qualification from an institution situated in any country outside India is still to be enrolled on a State Medical Register and is yet to have his or her name entered in the Indian Medical Register. The consequence of passing a screening test is that the person would be entitled to have his or her name registered on the Medical Register maintained by the State Medical Council or to have his or her name registered in the Indian Medical Register. These provisions make it clear that the object and purpose of a screening test is not to recognise an additional medical qualification which is obtained by a student after being registered on the State Medical Register or as the case may be after his or her name is entered in the Indian Medical Register. Once the student on the strength of a medical qualification which is obtained from an institution situated outside India has appeared at the screening test and upon qualifying the screening test has been enrolled on a State Medical Register or, in consequence, has been entered upon the Indian Medical Register, the purpose of the screening test is duly met. Section 13(4A) does not apply at a stage where the person who is already enrolled on the State Medical Register obtains an additional qualification in terms of a postgraduate degree from an institution abroad.

18.              Section 26(1) deals with a situation where a person who is already on the Indian Medical Register has inter alia obtained a qualification in medicine which is a recognised medical qualification. A person who obtains a recognised medical qualification is, on an application made in that behalf, entitled to have an entry stating such qualification against his or her name in the Indian Medical Register. The purpose of having a screening test in Section 13(4A) is not to enable an additional qualification within the meaning of Section 26 to be entered against the name of a person in the Indian Medical Register. This can be done under sub-section (1) of Section 26 where the qualification itself is a recognised