Kerala High Court Rules Against Mandatory CRRI for Eligible Foreign Medical Graduates

Introduction

The Kerala High Court, in the case of Sadhiya Siyad v. State Of Kerala (W.P.(C) No. 18825 of 2021), delivered a landmark judgment on October 20, 2021. This case addressed the requirements imposed by the State Medical Council (SMC) regarding the registration of foreign medical graduates in Kerala. The petitioner, Sadhiya Siyad, sought permanent registration to practice medicine in Kerala without undergoing the Compulsory Rotatory Residential Internship (CRRI), which the SMC had mandated based on its internal decision (Ext.P21).

The core issues revolved around the interpretation of the Indian Medical Council Act, 1956 (IMC Act), especially Sections 13(4A) and 13(4B), and the interplay between national regulations and state-level requirements for medical practice.

This commentary delves into the nuances of the judgment, analyzing the legal reasoning, precedents cited, and the potential implications for future medical registrations in India.

Summary of the Judgment

The petitioner, Sadhiya Siyad, obtained her medical degree from Dubai Medical College for Girls in 2019 and completed a one-year internship in Dubai Health Authority-approved hospitals. She subsequently cleared the licensing examination conducted by the Dubai Health Authority and obtained registration on November 18, 2020. In June 2019, she also cleared the Screening Test under Section 13(4A) of the IMC Act, making her eligible for registration in India.

Despite fulfilling these criteria, the SMC of Kerala demanded that she undergo CRRI as per Ext.P21, a decision enacted in October 2017, arguing it was necessary for gaining local clinical experience and understanding regional healthcare dynamics. The petitioner contended that having completed an internship abroad should exempt her from this additional requirement.

The Kerala High Court, presided over by Justice P.B. Suresh Kumar, examined the validity of Ext.P21 and its consistency with the IMC Act and associated regulations. The Court concluded that the CRRI requirement imposed by the SMC was inconsistent with the IMC Act and the Medical Council of India's regulations. Consequently, the Court directed the SMC to grant permanent registration to the petitioner without insisting on CRRI, provided her application met all other eligibility criteria.

Analysis

Precedents Cited

The judgment referenced several key precedents that influenced its outcome:

Ishan Kaul v. Medical Council of India (2010 KHC 6491): Clarified that the Eligibility Certificate under Section 13(4B) is student-specific and not institution-specific, meaning eligibility pertains to the individual rather than the institution they attended.
Shambhavi Sharma v. National Board of Examinations (2010 SCC OnLine Del 4490): Held that even if a candidate fails to obtain the Eligibility Certificate before admission, they should not be denied the right to appear for the Screening Test if they are otherwise eligible.
Medical Council of India v. State of Karnataka (1998) 6 SCC 131: Established that national laws (IMC Act) take precedence over state enactments, reinforcing that state decisions cannot contravene national regulations.
Siddharam Satlingappa Mhetre v. State of Maharashtra (2011) 1 SCC 694, Municipal Corporation Of Delhi v. Gurnam Kaur (1989) 1 SCC 101, and Jagannath Temple Managing Committee v. Siddha Math (2015) 16 SCC 542: Cited to support the Court's authority to make independent decisions on matters affecting statutory provisions and public interest.

Legal Reasoning

The Court meticulously analyzed the definitions and provisions under the IMC Act and the associated Regulations framed by the Medical Council of India. Key points included:

Primary Medical Qualification: Defined as a medical degree from a recognized institution abroad, equivalent to MBBS in India.
Eligibility for Screening Test: Emphasized that possessing a primary medical qualification and having passed the Screening Test are sufficient for registration, without mandating additional internships like CRRI.
Regulation 11 of the Regulations: Clearly stated that candidates who complete a one-year internship abroad and pass the Screening Test are entitled to permanent registration without needing further internships.
State Medical Council's Authority: Positioned the SMC's Ext.P21 decision as overreaching national regulations, asserting that state bodies cannot impose additional requirements that contradict national laws.

The Court concluded that the CRRI requirement was not only inconsistent with the IMC Act but also undermined the sanctity of the Screening Test by allowing state bodies to impose arbitrary additional requirements post-clearance. Therefore, once a candidate meets the IMC Act's criteria and passes the Screening Test, they are entitled to permanent registration without further obligations.

Impact

This judgment has significant implications for foreign medical graduates seeking registration in India:

Streamlining Registration: Eliminates unnecessary barriers for eligible foreign graduates, facilitating smoother integration into the Indian medical workforce.
Precedence of National Laws: Reinforces the supremacy of national regulations over state directives, ensuring uniformity in medical practice standards across India.
Judicial Oversight: Empowers courts to review and nullify state decisions that conflict with national statutes, safeguarding applicants' rights and interests.
Policy Implications: May prompt the National Medical Commission (NMC), successor to the Medical Council of India, to review and possibly revise registration procedures to align with legal precedents.

Complex Concepts Simplified

Eligibility Certificate (Section 13(4B) of IMC Act)

An Eligibility Certificate is a document issued by the Medical Council of India (now National Medical Commission) that certifies a candidate's eligibility to study medicine abroad and subsequently practice in India upon meeting other criteria. It is specific to the individual, ensuring they meet the necessary academic and regulatory standards.

Compulsory Rotatory Residential Internship (CRRI)

CRRI refers to a mandated one-year internship within India for medical graduates. Its purpose is to familiarize foreign-trained doctors with local medical practices, languages, cultural contexts, and the Indian healthcare system. However, this judgment questions its mandatory status for those who have already undergone substantial internship abroad.

State Medical Council (SMC)

SMCs are state-level regulatory bodies responsible for maintaining the State Medical Register, regulating medical practice, and ensuring that practitioners adhere to established standards. They operate under the respective State Medical Practitioners Acts, such as the Travancore Cochin Medical Practitioners Act (TCMP Act) in Kerala.

Screening Test (Section 13(4A) of IMC Act)

The Screening Test is an examination that foreign medical graduates must pass to qualify for registration on a State Medical Register in India. It assesses the candidate's medical knowledge, skills, and suitability to practice in the Indian healthcare environment.

Conclusion

The Kerala High Court's decision in Sadhiya Siyad v. State Of Kerala establishes a crucial precedent reinforcing the primacy of national regulations over state-imposed requirements in the medical registration process. By ruling that mandatory CRRI cannot be imposed on eligible foreign medical graduates who have completed requisite internships abroad, the Court has streamlined the pathway for international medical professionals to integrate into India's healthcare system.

This judgment not only upholds the rights of medical practitioners to gain employment based on their international qualifications but also ensures consistency and fairness in the regulatory framework governing medical practice in India. Moving forward, this decision is likely to influence both state medical councils and national regulatory bodies to harmonize their registration procedures, ultimately benefiting both medical professionals and the broader healthcare landscape in India.