NMC: Exposing How It Is Failing Patients and Shielding Doctors

NMC, the National Medical Commission is a statutory body in India tasked with regulating medical education, medical professionals, institutes, and research. This commission replaced the Medical Council of India (MCI) in September 2020. The MCI, plagued by corruption and a host of other issues, had long been criticised for its inefficiencies and lack of transparency. The establishment of the NMC was seen as a necessary step to rectify these deep-rooted problems and usher in a new era of improved oversight and governance in India's medical field.

Sadly, the NMC could not erase the taint left by the MCI. In fact, the National Medical Commission has institutionalised the very wrong practices that the MCI used to conduct behind closed doors, but now it does so openly. Instead of acting in the best interests of the citizens, as mandated in its own mission statement, the Commission appears to be serving the interests of doctors and hospitals. 

Despite its lofty mission statement, the National Medical Commission has often fallen short of its professed goals. The Commission claims to ensure the availability of adequate and high-quality medical professionals in all parts of the country, promote equitable and universal healthcare, and encourage a community health perspective that makes medical services accessible to all citizens. It also pledges to encourage medical professionals to adopt the latest research in their work and contribute to ongoing studies. 

Additionally, the National Medical Commission promises to objectively assess medical institutions periodically in a transparent manner, enforce high ethical standards across all aspects of medical services, and maintain an effective grievance redressal mechanism.

However, in practice, the Commission frequently appears to deviate from these principles. Instead of upholding the public interest, the commission seems to prioritise the interests of medical practitioners and hospitals. This troubling reality suggests that the Commission, in performing its duties, often forgets its own mission statement, thus compromising its integrity and failing the citizens it was designed to serve.

Rules to Protect Patients or Negligent Doctors?

Here is a stark example of how the NMC's rules and regulations are negatively impacting the lives of patients on the ground. Uttam Chand Meena lost his wife, Gargi Meena, in 2018 due to alleged medical negligence. Gargi had a minor stomach pain and went to Saroj Super Speciality Hospital in Delhi for medication. However, instead of providing her with medicines, the hospital's doctors performed surgery on her, and she eventually died. Following Gargi Meena’s death, her husband, Uttam Chand Meena, has been tirelessly seeking justice for his wife, running from pillar to post in a desperate attempt to hold those responsible accountable.

Uttam Chand Meena approached the Delhi Medical Council in 2019 regarding the negligence of the doctors. The DMC's 2021 order in this case clearly states that the doctor in question failed to exercise a reasonable degree of skill, care, and knowledge expected of a prudent doctor in managing the case. The order also highlights that the anaesthetist failed to exercise due diligence in record-keeping, and the physician was not diligent in the management of the patient. Despite these findings, the DMC's order only imposed a 30-day suspension on the main doctor, while the anaesthetist and the physician received merely a warning. This lenient action left Uttam Chand Meena disheartened and questioning the effectiveness of the regulatory system meant to protect patients.

"I was devastated by the Delhi Medical Council’s order of 2021. Medical negligence killed my wife, and the doctor received only a 30-day suspension while the anaesthetist and physician were merely given a warning. So, you kill a patient and only get warned not to do it again? I decided to approach the National Medical Commission in 2021. But almost three years later, the Commission still hasn't pronounced my order. They are just delaying it. I then approached the Delhi High Court, and the court issued an order at the beginning of 2024 asking the NMC to wind up the matter and pronounce an order. Even when the court asks you to wrap up, you won't. Who is the National Medical Commission really serving?" asks Uttam Chand Meena. 

The Problem Isn't Just Delays, It's the Law Itself

The matter does not end here. The larger issue in this case, and many others, is not just that the National Medical Commission has been delaying the pronouncement of orders. Even if we cut some slack to the Commission, the actual problem is far more serious. The problem is that the Commission changed the law itself, ensuring that patients who have an issue with the state medical council’s orders cannot appeal, while doctors retain the right to appeal. This legal shift fundamentally skews the balance of justice in favour of medical practitioners, leaving patients and their families without an avenue for recourse.

The National Medical Commission Act of 2019 was introduced to ensure the availability of high-quality medical professionals across the country, promote equitable and universal healthcare with a community health perspective, make medical services accessible to all citizens, promote national health goals, and enforce high ethical standards in all aspects of medical services. Although the Act begins with these commendable goals, a closer examination reveals troubling provisions. 

One of the most controversial aspects in Section 30 (3) states: "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." This clause effectively allows medical practitioners (doctors) to appeal decisions made by State Medical Councils, while patients are left without a similar recourse, creating an imbalanced system that favours medical professionals over those they are meant to serve.

Patients Left Vulnerable by Biased Medical Laws

Uttam Chand Meena, in the case of Gargi Meena’s death, also had concerns about the educational qualifications of a concerned doctor. "The Delhi Medical Council did not want to entertain my complaint. They said it is the duty of the MCI to check and verify the qualifications of the doctor. So I appealed before the National Medical Commission, and the Commission told me that they couldn’t hear my case because of Section 30 (3) of the National Medical Commission Act of 2019," he explains.

Meena then took this fight to the highest court in the country. In 2023, he filed a public interest litigation (PIL) in the Supreme Court challenging the controversial Section 30 (3) of the National Medical Commission Act of 2019. Meena’s PIL does not stop there; it also brings to light another contentious rule under the National Medical Commission Registered Medical Practitioner (Professional Conduct) Regulations 2023. This regulation has raised significant concerns about the lack of accountability and oversight in the medical profession, further undermining patients' rights. 

Under these regulations, Section 44 stands out as one of the most controversial. This section addresses the appeals process and clearly states that a Registered Medical Practitioner, meaning the doctor, has the right to file an appeal before the Ethics and Medical Registration Board (EMRB) within 60 days from the date of the order issued by the respective state medical council if they are aggrieved by the decision. 

This controversial rule again grants doctors the right to appeal before the EMRB but remains conspicuously silent about the patients' right to appeal. This omission has drawn huge criticism as it underscores a systemic bias favouring medical professionals over the very patients they are meant to serve. The lack of a parallel provision for patients seeking to challenge state medical council decisions further entrenches this imbalance, leaving individuals like Meena with limited recourse in their quest for justice.

Not Just Meena: Uncovering More Victims of the Law

In February 2022, another victim of medical negligence, Sujata Mitra from Kolkata, found herself disheartened by the West Bengal Medical Council’s order in her case. Seeking justice, she filed an appeal before the National Medical Council’s Ethics and Medical Registration Board (EMRB).

However, in March 2022, the Commission’s Ethics and Medical Registration Board responded that her appeal was non-maintainable, citing Section 30 (3) of the National Medical Commission Act of 2019. This section, which restricts patients' rights to appeal, left Sujata without a path to challenge the decision, exposing yet another instance of the systemic bias embedded in the current regulatory framework.

In the letter, the Commission states, "The National Medical Commission, in its meeting held on 16.10.2021, reiterated that based on the NMC Act of 2019, appeals from only medical practitioners or professionals should be allowed as appeals before the Ethics and Medical Registration Board (EMRB) under Section 30 (3) of the National Medical Commission Act of 2019. Accordingly, it has been decided by the EMRB that all appeals from non-medical practitioners or professionals filed on or after the coming into force of all provisions of the National Medical Commission Act of 2019, with effect from 25th September 2020, shall be returned in pursuance of the provision under Section 30 (3) of the NMC Act of 2019." 

As a result, Sujata Mitra’s appeal was returned. This decision exposes the regulatory framework's inherent bias, leaving victims like Sujata without a viable avenue for seeking justice and challenging state medical council decisions while the same right denied to the patient is given to the doctor. It is an outright and blatant misuse of power, executed in an institutionalised manner where the law itself was written to strip patients of their rights. This intentional legal framework not only undermines the principles of justice and fairness but also leaves victims of medical negligence, like Sujata Mitra, without any recourse to challenge the inadequacies of the system meant to protect them.

Mihir Banerjee, the Vice President of People for Better Treatment (PBT), an organisation that helps victims of medical negligence, highlights how the law was not always this skewed. The earlier Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations 2002, under Sections 8.7 and 8.8, provided significant protection for patients' rights. These regulations stipulated that if a State Medical Council failed to resolve a complaint against a physician within six months without a valid reason, the Medical Council of India (MCI) could urge the state council to expedite the process or withdraw the complaint for its own Ethical Committee to resolve within the same timeframe. 

Furthermore, the regulations allowed anyone dissatisfied with a State Medical Council's decision to appeal to the MCI within 60 days, with the possibility of an additional 60-day extension for valid reasons. This framework ensured a more balanced approach, offering patients a fair chance to seek justice and hold medical professionals accountable.

We spoke to Dr. Kunal Saha, the President of People for Better Treatment. Dr. Saha has been crusading against medical negligence, driven by his own tragic experience of losing his wife, Anuradha Saha, to medical negligence. What began as a personal fight for justice in the late 90s soon evolved into a nationwide movement.

The Anuradha Saha judgement became one of the most historic rulings in India related to medical negligence, resulting in Dr. Saha receiving a groundbreaking compensation of ₹11.5 crore. This landmark case not only brought Dr. Saha a measure of justice but also highlighted the urgent need for systemic changes in the medical regulatory framework to protect patients' rights.

Speaking to The Probe, Dr. Saha revealed that numerous victims of medical negligence have been seeking advice from him and his organisation, PBT, due to the National Medical Commission's consistent rejection of their appeals. "The law is so skewed and one-sided that countless victims of medical negligence approach us for help. Despite the NMC's rejections, we still advise them to send appeals to the Commission and, when taking their cases to court, to reference Sections 8.7 and 8.8 of the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations 2002. These sections provide patients the right to appeal, and the Supreme Court continues to pass judgments quoting them. So, why shouldn't we still use these provisions? How can the National Medical Commission justify rejecting the pleas of patients so blatantly?" Dr. Saha questions the fairness and transparency of the NMC's decisions, urging victims to persist in their fight for justice using all available legal avenues. 

Larger Issues Related to Transparency

While the NMC proclaims in its mission statement that it aims to ensure the availability of adequate and high-quality medical professionals in all parts of the country, objectively assess medical institutions periodically in a transparent manner, maintain a medical register for India, enforce high ethical standards in all aspects of medical services, and have an effective grievance redressal mechanism, even the basic levels of transparency are not maintained.

For instance, patients should have the right to know who the doctors treating them are by their face, their registration number, and their qualifications. However, to date, the websites of the state medical councils only disclose the registration number, registration date, date of expiry of registration of the doctors, and their qualifications. Notably, the most crucial piece of information, which is their photograph, is missing. In the absence of a photograph, how can a patient even know if the doctor treating them is indeed the same person whose details are listed on the government website?

Moreover, like many other government organisations in the country that have been embroiled in controversy for openly professing Hindutva-related ideology, the NMC was also in the thick of controversy last year when it changed its logo to feature a colourful image of Dhanvantari, an avatar of the Hindu god Vishnu, who is considered the god of Ayurveda in Hindu mythology. The commission courted controversy after it replaced the national emblem of India with the Hindu deity's image. It also began referring to itself as the "National Medical Commission - Bharat," replacing "India," which triggered speculations about the BJP's alleged plans to remove the word "India" from the Constitution.

The Commission was also amidst controversy last year over its members' non-disclosure of assets. Despite directions from the Prime Minister’s Office (PMO) to do so, the National Medical Commission members had not declared their assets online. The PMO had directed the Ministry of Health and Family Welfare to take “appropriate action” on a complaint against non-disclosure of assets by NMC members, including its chairman, on October 23 last year. This lack of compliance with transparency directives further undermines the credibility and accountability of the Commission.

This article will be updated as soon as we get a response from NMC. 

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