National Medical Commission: How It Lied and Misled the Supreme Court

National Medical Commission Exposed

On November 23, 2023, The Probe exposed a critical public interest story that cast a spotlight on a deeply flawed and arguably unconstitutional regulation by the National Medical Commission (NMC) – the statutory body overseeing medical professionals, medical education, and institutions across India. At the centre of this controversy was Section 30(3) of the National Medical Commission Act, 2019 and Regulation 44 of the National Medical Commission Registered Medical Practitioner (Professional Conduct) Regulations 2023. These rules, alarmingly, strips victims of medical negligence and their families of any legal recourse if their State Medical Councils fail to act or deliver justice. In a disturbing contrast, the very doctors accused of malpractice are granted the right to appeal decisions made by State Medical Councils, if they believe justice has not been served. 

In simple terms, these rules create a glaring disparity in how justice is served in cases of medical negligence. When a patient suffers medical malpractice and approaches the State Medical Council for justice, the situation becomes unjust if the council rules in favour of the doctor or hospital. In such cases, the patient is denied the right to appeal to the NMC. However, if the same State Medical Council rules against the doctor, the doctor is granted the right to appeal before the NMC. This one-sided rule effectively strips patients of their fundamental right to seek justice from the very statutory body meant to regulate medical professionals. In The Probe’s 2023 report, we argued that this provision is not only unconstitutional but also deeply unjust, calling for immediate intervention from the courts to rectify this gross imbalance.

The Contentious Rules 

For years, the National Medical Commission consistently invoked the controversial Section 30(3) of the NMC Act of 2019 to reject appeals from many victims of medical negligence. It had become routine practice for the NMC to return these appeals of alleged victims, leaving patients and their families without any recourse after adverse rulings from State Medical Councils. 

Following the introduction of the contentious NMC Act 2019, the government further entrenched this imbalance by implementing the National Medical Commission Registered Medical Practitioner (Professional Conduct) Regulations 2023 on August 2, 2023. These regulations explicitly reinforced the rule that only Registered Medical Practitioners (RMPs) - which means registered doctors -  have the right to appeal decisions made by State Medical Councils. Under Regulation 44, the message was clear: while patients and their families remain powerless to contest unfavourable verdicts from the State Medical Council, doctors are afforded the privilege of appealing decisions that they deem unsatisfactory. 

National Medical Commission Exposed

On November 23, 2023, The Probe exposed a critical public interest story that cast a spotlight on a deeply flawed and arguably unconstitutional regulation by the National Medical Commission (NMC) – the statutory body overseeing medical professionals, medical education, and institutions across India. At the centre of this controversy was Section 30(3) of the National Medical Commission Act, 2019 and Regulation 44 of the National Medical Commission Registered Medical Practitioner (Professional Conduct) Regulations 2023. These rules, alarmingly, strips victims of medical negligence and their families of any legal recourse if their State Medical Councils fail to act or deliver justice. In a disturbing contrast, the very doctors accused of malpractice are granted the right to appeal decisions made by State Medical Councils, if they believe justice has not been served. 

In simple terms, these rules create a glaring disparity in how justice is served in cases of medical negligence. When a patient suffers medical malpractice and approaches the State Medical Council for justice, the situation becomes unjust if the council rules in favour of the doctor or hospital. In such cases, the patient is denied the right to appeal to the NMC. However, if the same State Medical Council rules against the doctor, the doctor is granted the right to appeal before the NMC. This one-sided rule effectively strips patients of their fundamental right to seek justice from the very statutory body meant to regulate medical professionals. In The Probe’s 2023 report, we argued that this provision is not only unconstitutional but also deeply unjust, calling for immediate intervention from the courts to rectify this gross imbalance.

The Contentious Rules 

For years, the National Medical Commission consistently invoked the controversial Section 30(3) of the NMC Act of 2019 to reject appeals from many victims of medical negligence. It had become routine practice for the NMC to return these appeals of alleged victims, leaving patients and their families without any recourse after adverse rulings from State Medical Councils. 

Following the introduction of the contentious NMC Act 2019, the government further entrenched this imbalance by implementing the National Medical Commission Registered Medical Practitioner (Professional Conduct) Regulations 2023 on August 2, 2023. These regulations explicitly reinforced the rule that only Registered Medical Practitioners (RMPs) - which means registered doctors -  have the right to appeal decisions made by State Medical Councils. Under Regulation 44, the message was clear: while patients and their families remain powerless to contest unfavourable verdicts from the State Medical Council, doctors are afforded the privilege of appealing decisions that they deem unsatisfactory. 

It took the courage of one man, Uttam Chand Meena, to challenge it at India’s highest court. Meena, whose wife Gargi Meena tragically died due to alleged medical negligence, filed a petition in the Supreme Court in 2023, seeking the judiciary's intervention. He demanded that Section 30(3) be struck down, citing its violation of Articles 14, 19, and 21 of the Indian Constitution, as well as Section 27(1)(d) of the NMC Act.

These legal protections form the backbone of citizens' rights in India. Article 14 guarantees equality before the law, ensuring that all individuals receive equal protection. Article 19 preserves essential freedoms, including the right to free speech, while Article 21 safeguards the right to life and personal liberty. Furthermore, Section 27(1)(d) of the NMC Act empowers the Commission to take disciplinary action against medical professionals/doctors for misconduct, a power that seemed to be undermined by the very existence of Section 30(3). 

Meena, represented by Advocate Prashant Vaxish, presented a compelling case against Regulation 44, arguing that it directly contravenes Section 27(1)(d) of the NMC Act, 2019. This provision grants the National Medical Commission the authority to impose disciplinary action on medical professionals for professional misconduct, a power that Regulation 44 effectively undermines by denying patients the right to appeal decisions made by State Medical Councils.

Moreover, Vaxish contended that Regulation 44 violates fundamental rights enshrined in Part III of the Constitution of India. Additionally, he emphasised the importance of Article 21, which protects the right to life and personal liberty, alongside the principle of natural justice that mandates fairness in legal proceedings and guards against arbitrary actions. 

NMC’s Shocking Admission Before the Supreme Court

When the case was brought before the Supreme Court on August 14, 2024 for hearing, the bench of Chief Justice of India, Justice DY Chandrachud along with Justice J.B Pardiwala and Justice Manoj Mishra pressed the Union Government and the NMC on the rationale behind the controversial provisions. The response from the lawyer representing the NMC and the Union Government was startling: They admitted that the disputed regulations were withdrawn long back - August 23, 2023 itself - a mere 21 days after the introduction of the new regulations. This revelation left many startled and questioning the validity of Meena's case, as the NMC's counsel argued that the ‘so called’ regulations that Meena is talking about no longer exists as it was long withdrawn. 

In a further twist, the NMC stated that with the withdrawal of the controversial regulations, the previous Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations of 2002 were reinstated on August 23, 2023. The IMC regulations 2002 provided a much clearer framework regarding misconduct and the appeals process. Specifically, Regulation 8.8 explicitly stated that both victims and doctors have the right to appeal decisions made by State Medical Councils. It read: "Any person aggrieved by the decision of the State Medical Council on any complaint against a delinquent physician shall have the right to file an appeal to the Medical Council of India (MCI) within a period of 60 days from the date of receipt of the order passed by the said Medical Council."

This shocking admission revealed a startling truth: until that moment, victims of medical negligence—including petitioner Meena—were unaware that the controversial regulations had been withdrawn in August 2023. Even the leading organisation advocating for victims of medical negligence, People for Better Treatment, was in the dark about the retraction. Journalists covering these issues were equally oblivious that the contentious rules had been withdrawn a year ago on August 23, 2023. Notably, the old ‘withdrawn’ rules remained listed on the NMC's website right up until 2024. This was the premise of our investigation. 

In light of this revelation, we posed critical questions: Did the NMC and the Union Government, anticipating potential rebuke from the Supreme Court for implementing such discriminatory regulations, retroactively alter the rules to avoid scrutiny? How could it be that no one in the country was aware of the withdrawal of these contentious regulations? Would it not be irresponsible for the media to merely blame the NMC and the government based on speculation without delving into the facts?

To address these concerns, we spoke with individuals who had seen and downloaded copies of the ‘withdrawn’ regulations from the NMC's website as late as 2024. If the rules had indeed been withdrawn, why were they still listed as current rules in 2024? However, simply gathering testimonies from those who had not seen the new rules was insufficient. We needed to delve deeper into the underlying issues of how regulations are manipulated, courts are misled, and citizens’ rights are violated in the country.

To substantiate our investigation, we sought solid documentary evidence of misconduct on the part of the NMC. We asked a key question: If the old regulations were withdrawn on August 23, 2023, did that mean patients were granted equal rights to appeal just like doctors? Between August 23, 2023, and the present day, had the NMC rejected any appeals from victims of medical negligence by citing the now-invalid rules? Or did the NMC take the high road, acknowledging the withdrawal of the controversial regulations and accept patient appeals?

As we dug deeper, we unearthed shocking evidence. We discovered extensive documentation demonstrating that the NMC continued to reject appeals from patients, favouring hospitals and doctors by asserting that patients had no right to appeal under the ‘withdrawn’ rule. The volume of evidence was staggering, indicating that even after the NMC's admission in court that the controversial rules were withdrawn, they continued to rely on these same outdated regulations to deny patients the right to appeal. This raises alarming implications. If the NMC operated under the withdrawn rules, it not only misled the Supreme Court but effectively escaped scrutiny while simultaneously stripping patients of their legal right to appeal. 

How the NMC Used Obsolete Laws to Deny Patients Their Right to Appeal

In a stunning revelation, The Probe has uncovered numerous documents that expose how the NMC continued to reject appeals from victims of medical negligence, even after the controversial regulations were allegedly withdrawn. Despite their admission before the Supreme Court that the discriminatory rules were rescinded, the NMC persisted in using these outdated provisions to deny patients their legal right to appeal.

One such document, accessed by The Probe, highlights the extent of this misconduct. On September 3, 2024, an email was sent by the Ethics section of the NMC to the family of a victim of alleged medical negligence. The email blatantly cited the withdrawn regulations, stating: “As per existing NMC Act 2019 only Registered Medical Practitioners can apply for first appeal in NMC. Inconvenience caused is deeply regretted.” 

In essence, the NMC is telling the patient’s family that patients cannot appeal, while doctors retain that right, citing the NMC Act of 2019. However, here's the twist: on August 14, 2024, as mentioned earlier, the NMC informed the Supreme Court that the controversial National Medical Commission Registered Medical Practitioner (Professional Conduct) Regulations, 2023 had been withdrawn. Furthermore, they stated that the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations of 2002 were reinstated on August 23, 2023.

If Regulation 8.8 of the Indian Medical Council (IMC) Regulations, 2002 provides patients the right to appeal, then the core question becomes: why did the NMC deny this right in this particular case, and on what grounds was the patient's appeal rejected?

If you think that the case we uncovered might have been a one-off mistake or a technical glitch by the NMC, the evidence suggests otherwise. In fact, we have gathered substantial documentation showing how the NMC has consistently rejected appeals from victims of medical negligence by citing outdated and non-existent regulations, effectively denying patients their right to appeal while quoting laws that no longer apply.

Dr. Kunal Saha, President of People for Better Treatment (PBT), an organisation dedicated to helping medical negligence victims, expressed his outrage over this issue. Dr. Saha, who has been a relentless advocate for patient rights, said: "I am absolutely outraged at the findings that the NMC knew that victims have the right to appeal decisions of the State Medical Councils yet they chose to not give patients this right. It was from our PIL before the Supreme Court years back that rules 8.7 and 8.8 were added, giving rights to patients. Regulation 8.7 of the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002, clearly states that State Medical Councils must complete investigations against doctors or hospitals within a period of six months. Regulation 8.8 explicitly says that any victim or complainant dissatisfied with the decision of the State Medical Council can appeal before the Medical Council of India (MCI), now the NMC. This was the law up until 2019."

Dr. Saha further explained how things took a troubling turn after 2019: "After 2019, when patients started sending appeals, paying a fee of ₹592, NMC started rejecting their appeals with the claim that they didn't have the right to appeal. Until you informed us, we never knew that the NMC had gone to court claiming that the controversial regulation had been withdrawn in August 2023. We've been fighting many cases for medical negligence victims, and this revelation is shocking. If the old 2002 regulation was reinstated, granting patients the right to appeal, why has the NMC continued rejecting these appeals even in 2024? This is absolutely outrageous, and we will file a PIL against the NMC over this matter."

Take a look at the document below, another piece of evidence of how the NMC has been mishandling these appeals. In this letter dated October 14, 2024, the NMC's Ethics and Medical Registration Board (EMRB) wrote to a victim’s family, rejecting their appeal as "non-maintainable under Section 30(3) of the NMC Act, 2019." 

While rejecting the appeal, Subodh Kumar, the Under Secretary with the NMC, stated the following: "A medical practitioner or professional who is aggrieved by any action taken by a State Medical Council under Sub Section (2) may prefer an appeal to the Ethics and Medical Registration Board against such action, and the decision, if any, of the Ethics and Medical Registration Board thereupon shall be binding on the State Medical Council, unless a second appeal is preferred under sub section (4)... The NMC in its meeting held on 16.10.21 reiterated that based on the NMC Act 2019, appeals from only medical practitioners or professionals should be allowed as appeals before Ethics & Medical Registration Board (EMRB) under Section 30(3) of the NMC Act, 2019 w.e.f 25th September 2020... In view of the above, your appeal dated 14.09.2024 against the decision of the West Bengal Medical Council is returned herewith."

Yet again, this leaves us questioning the NMC's approach. As per the NMC’s own submission before the Supreme Court, the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations of 2002 — which grant patients the right to appeal — are the current regulations in force. So why, as recently as this month, is the NMC still rejecting patients' appeals and effectively stripping victims of medical negligence of their legal right to appeal?

Prashant Vaxish, the lawyer representing Meena, expressed his strong condemnation of the NMC's actions, calling it a "blatant disregard for the rule of law." He stated, "The rights of patients have been reduced to a mere piece of paper by the central government and its agencies, even at the cost of public health and the lives of citizens. The entire intent of the NMC seems to be removing the accountability of doctors towards their patients. We still believe, under the culture and custom of our nation, that a doctor, wearing the White Coat, is equivalent to God. But unfortunately, we have reached a point where the faith and trust of citizens have been tarnished merely for political convenience. Why does the central government and its agencies show such disregard for the constitutional provisions of fundamental rights? This government and its agencies operate with double standards, ignoring the pleas of the very people who entrusted them with power for another five years."

The revelations surrounding the NMC’s actions have ignited widespread outrage, casting serious doubts on its integrity and commitment to maintaining medical standards and safeguarding patients' rights in India. It is now evident that the Supreme Court was misled into believing that the contentious regulations had been withdrawn, when in reality this is not the case. The consequences of deceiving both the judiciary and the public cannot be understated, and it is crucial that the National Medical Commission be held to the highest standards of ethics and responsibility.

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