On May 2023, the SC directed the NMC to set up a panel of experts to examine a plea for evolving modes of disability assessment for students seeking MBBS admission.
Based on these new NMC guidelines, 8 successful candidates with dyslexia were denied admission to MBBS by the Delhi High Court. (Commons)
UPDATE: The NMC Circular, dated 12.06.2023, which issued Guidelines under the Graduate Medical Education Regulations 2023, has been “WITHDRAWN AND CANCELLED” after the publication of the piece on 23.06.23. It has been reposted on the NMC website as a public notice, seeking comments from stakeholders on the NMC (Competency Based Medical Education Curriculum) Regulations, 2023 (until 22 July 2023).
Last year, in April, an unexpected visitor came to my office. It was the father of a 23-year-old who had Obsessive Compulsive Disorder (OCD). The young man had cleared the National Eligibility cum Entrance Test-Under Graduate (NEET-UG) exam and secured admission to AIIMS Deoghar. However, his admission to MBBS was denied.
The father was visibly furious. He said, “What should I do now, sir? Mental illness should not have been included among the 21 disabilities. This turned out to be an empty promise. There doesn’t seem to be any reservation anywhere. This will demean children with disability, and they might even resort to suicide. If it is in the law, they should be entitled to reservation.”
The father approached the Delhi High Court for relief but was unsuccessful due to the guidelines set by the National Medical Commission (NMC). He then took his case to the Supreme Court of India, which, after conducting hearings, directed the NMC — in an order dated 18 May of this year — to set up a panel of domain experts.
The purpose of this panel was to examine a plea for evolving modes of disability assessment for students with psychological disabilities (mental illness, specific learning disability, autism, etc) to grant them quotas in MBBS admissions.
The NMC counsel stated that a committee had been formed and that the matter was currently at an advanced stage. The petition is now scheduled to be heard on 17 July.
However, it is worth noting that the NEET-UG results have already been announced, and the new MBBS batch is set to commence on 1 August.
Around the time I was listening to the distraught father in my office, the Delhi High Court, in the case of Neha Pudil v Union of India on 18 April, 2022, directed the NMC to review its existing 14 May, 2019, guidelines for learners with disabilities in MBBS.
The high court emphasised that the review should be in consonance with the Rights of Persons with Disabilities Act (RPDA) of 2016 and should consider advancement in modern science. The high court gave the NMC a timeline of six months to suggest amendments, which should have been completed by October 2022, when the father was compelled to approach the SC.
What is surprising is that NMC counsel was aware of these legal updates and should have informed the apex court accordingly. Around the same time, my petition from 2021, which called for the streamlining of disability assessment centres and the inclusion of doctors with disabilities in the committee responsible for reviewing NMC guidelines, reached the stage of video conference hearing in the Court of Chief Commissioner for Persons with Disabilities on 1 December, 2022.
During the hearing, the under secretary of the NMC stated that a committee had been formed following the Delhi High Court order. This NMC committee later held a meeting on 19 December, 2022, attended by the presidents of the undergraduate, postgraduate, and medical ethics board (one of whom happened to be the former director of NIMHANS) and chosen experts where they finalised the guidelines which allowed candidates with psychosocial disabilities.
However, this information was not shared in the Supreme Court despite a media report about the “progressive” guideline for those with mental illness, published in the Indian Express on 23 May this year.
The apex court has scheduled the next hearing for 17 July. Unfortunately, this delay might prove to be heartbreaking for the petitioner because, in an unexpected move, despite the matter being with the top court, the NMC, in its circular dated 12 June on “Guidelines for Undergraduate Medical Education Regulations 2023”, continued to use the existing 14 May, 2019, guidelines which debars successful NEET candidates with psychosocial disabilities from pursuing MBBS.
Courts refuse to intervene when an expert committee of doctors makes a decision. While this may have merit, it makes no sense when a single individual, without proper knowledge, has the power to influence matters that will impact the careers of thousands of MBBS aspirants.
Under the previous 1995 Disability Act, quota benefits were only provided to candidates with locomotor disabilities of the lower limbs. However, after the passage of the landmark RPDA 2016, which included learning disabilities and autism as recognised disabilities with a five percent reservation in higher education, the Ministry of Health directed the NMC to frame new guidelines for persons with disabilities seeking MBBS admission.
Six experts were chosen by the NMC to frame pan-India guidelines for 21 disabilities. All experts were from Delhi and five of them from a single institute. The lone member of the MCI committee responsible for setting guidelines for dyslexia, autism, and mental illness was a psychiatrist (let’s refer to him as Dr Know-It-All) who emailed the NMC staff to share the best practices available globally so that he can frame his recommendations.
This was made available to me after my RTI to get the minutes of the meeting of this committee. Despite candidates with psychological disabilities successfully pursuing medicine abroad, Dr Know-It-All did not recommend medical admission for this group. Instead, he expressed concerns about potential fraudulent disability certificates without providing any supporting references for his claim.
Based on these guidelines, eight successful candidates with dyslexia were denied admission to MBBS by the Bombay High Court. One of the students with dyslexia from my own medical college had their admission cancelled, but they approached the high court for redress. A letter from 75 doctors with disabilities was submitted to the Health Ministry, resulting in certain controversial parts of the NMC guidelines being amended. Following the judgement in the Ashutosh Purswani v Union of India in the Supreme Court, the Delhi High Court reinstated the admission of the dyslexic student. However, others were not as fortunate.
A talented student with OCD was rejected by the Maharashtra disability centre and the Bombay High Court. Although he enrolled in engineering, his dream was always to become a doctor. He reapplied for NEET, was selected once again, but faced rejection once more. The list of candidates with such unsuccessful outcomes is extensive. Surprisingly, neither the medical associations nor the Indian Psychiatric Society questioned the false claim made by Dr Know-It-All in the NMC gazette, which stated the “lack of objective method/quantification of disability to establish presence and extent of mental illness”.
Unlike the previous committee, which had only one psychiatrist, the NMC included two expert psychiatrists this time: Dr Jagadisha T from NIMHANS and Dr Ram Pratap Beniwal from RML Hospital.
They trashed the argument put forth to exclude individuals with mental illness from pursuing the MBBS course based on the notion that that their inclusion would compromise patient safety. They said that those individuals with disabilities who are able to successfully complete the MBBS programme, including passing entrance exam and all levels of exams and internships, would be just as capable of ensuring patient safety as those without disabilities.
They cited a recent Supreme Court order (Bhavya Nain case) to emphasise that concerns regarding patient safety cannot be used as a justification to exclude such individuals from pursuing MBBS. They also evoked RPDA 2016, which does not provide for exclusion of persons with disability from any educational institutions.
In an unexpected move as NMC experts, they further criticised the guidelines framed by Dr Know-It-All, describing them as “untenable” considering that the government has issued guidelines for assessment of disabilities, including disability due to mental illness, through formal gazette notifications. The NMC’s previous position contradicts this and it may be subject to legal challenge.
If there is lack of objective method to establish the presence and extent of mental illness, then how is it that the NMC disqualifies persons with disabilities equal to or above 40 percent from pursuing the MBBS course? Unlike Dr Know-It-All, these well-informed psychiatrists, relying on court orders and best practices, also advocate for candidates with learning disabilities and autism to be allowed to pursue MBBS.
The NMC has further complicated the situation with its latest circular dated 12 June 2023, which employs existing discriminatory guidelines that have now been criticised by experts within the NMC. However, considering that the new batch of students will be joining from 1 August, it is now up to the Supreme Court to intervene.
We must also spare a thought for the countless number of meritorious individuals with psychological disabilities who are denied the opportunity to become doctors due to the implicit and explicit bias of a single psychiatrist. These same students are pursuing equally challenging professions like engineering and medicine outside of India, but where is the accountability of the medical fraternity towards the injustice inflicted by one of their own colleagues?
(The author is a medical doctor and a disability rights advocate who is also Co-chair of the International Council for Disability Inclusion in Medical Education. Views are personal.)
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