Holding

The NMC's Licentiate and CRMI Regulations are within the statutory powers granted by the NMC Act and do not contravene Articles 14, 19(1)(g) or 21 of the Constitution.

Summary

The appellant, a student who could not pursue a medical degree abroad due to the pandemic, challenged the National Medical Commission's (NMC) 2021 Licentiate Regulations and Compulsory Rotating Medical Internship (CRMI) Regulations, alleging they were ultra vires and violated Articles 14, 19(1)(g) and 21 of the Constitution. The challenged provisions required a minimum 54‑month course duration, a 12‑month internship in the foreign institution, registration with the foreign professional body, and a further 12‑month supervised internship in India, as well as parity of internship requirements for foreign graduates under the CRMI Regulations. The Supreme Court examined the NMC's statutory powers under the NMC Act and the earlier Indian Medical Council Act, and held that prescribing minimum standards, including course duration and internship, is within the Commission's competence and does not constitute extra‑territorial legislation. The Court found no infringement of the constitutional rights asserted and dismissed the appeals, waiving the costs imposed by the High Court.

Issues considered

The validity of Regulation 4(a)(i), 4(a)(ii), 4(b) and 4(c) of the Licentiate Regulations under the NMC Act
Whether the Licentiate Regulations violate Articles 14, 19(1)(g) and 21 of the Constitution
Whether the Regulations amount to extra‑territorial legislation
The validity of Schedule‑II Para 2(a)(i) and 2(c)(i) of the CRMI Regulations
The scope of NMC's power under Sections 15(4), 33, 36 and 57 of the NMC Act

Legislation cited

Indian Medical Council Act, 1956s. 11, s. 12, s. 13, s. 36(4), s. 60
National Medical Commission Act, 2019s. 15(4), s. 33, s. 36, s. 57, s. 57(2)(k)

Subjects

National Medical Commissionforeign medical graduateLicentiate RegulationsCompulsory Rotating Medical Internshipconstitutional challengeArticle 14Article 19(1)(g)Article 21extra‑territorial legislationminimum standardsmedical registrationinternship requirement

Judgment

[2022] 5 S.C.R. 921 921

ARAVINTH R.A. A
v.
THE SECRETARY TO THE GOVERNMENT OF INDIA
MINISTRY OF HEALTH AND FAMILY WELFARE & ORS.
B
(Civil Appeal No. (s) 3585-3586 of 2022)
MAY 02, 2022
[HEMANT GUPTA AND V. RAMASUBRAMANIAN, JJ.]
National Medical Commission (Foreign Medical Graduate C
Licentiate) Regulations 2021 – Regn.4(a)(i), 4(a)(ii), 4(b) & 4(c) –
Consitutionality of – The challenge to Regn.4(a)(i) was based upon
the premise that it puts an obligation upon students seeking foreign
medical course to select only that Institution which offer the course
of a duration of 54 months – The challenge to Regn.4(a)(ii) and
4(b) was based upon the ground that it was an extra territorial D
legislation as it makes mandatory for foreign medical graduate to
undergo 12 months internship in the same foreign medical institution
and also to get registered in that country’s professional regulatory
body – The challenge to Regn.4(c) was on the basis that the same
caused undue hardship to foreign medical graduate as it mandates E
12 month supervised internship in India thus compelling them to
undergo two internships, one in the foreign land and another in the
mother land – Writ petition dismissed by High Court on the ground
that that the said provisions do not violate Arts.14, 19(1)(g) and 21
of the Constitution – Correctness of – Held: Correct – Prescription
of minimum standards would certainly include the prescription F
of the minimum duration for a course and it may be open to the
medical institutions of other countries to prescribe a duration of
less than 54 months for the students of their country but it is not
necessary for the National Medical Commission and the Central
Government to recognise foreign medical degrees of a lesser G
duration, if the incumbent wants to have permanent registration in
India – The prescription of an internship for a minimum duration
of 12 months in the same foreign medical institution cannot be said
to be a duplication of internships since the purpose of internship
is to test the ability of the students to apply their academic
H
921
922 SUPREME COURT REPORTS [2022] 5 S.C.R.

A knowledge on their subjects, namely the patients – Constitution of
India – Arts.14, 19(1)(g) and 21.
National Medical Commission (Compulsory Rotating Medical
Internship) Regulations, 2021 – Schedule -II 2(a) and 2(c)(i) –
Schedule II- Para 2(a)(i) requires all foreign medical graduate to
B undergo internship at par with Indian Medical Graduate – The
challenge to Schedule-II Para 2(c)(i) is upon the premise that the
same puts a question mark upon the future of students as it requires
foreign medical gradutes to be first posted in colleges which have
been newly opened and yet to be recognised – High Court dismissed
the writ petition holding that the none of the provision violate Arts.14,
C
19(1)(g) and 21 of the Constitution – On appeal, held: The
requirement under Para 2(a) of Schedule-I for foreign medical
graduates to undergo internships at par with Indian medical
graduates is to ensure that only those who have acquired similar
skills are allowed to practice Medicine and therefore challenge to
D the same is without any substance – The prescription in para 2(c)(i)
of Schedule-II that such foreign medical graduates may be posted
first in colleges which have been newly opened and have yet to be
recognised, is a prescription of necessity since all medical
institutions of the country are equipped to provide internships only
to as many students as their permitted intake may allow and
E
therefore, the Regulation is intended to ensure that an undue burden
is not cast upon the already recognised institutions.
Dismissing the appeals, the Court
HELD: 1. The appellant challenged the validity of Regulation
F 4(a)(i) and Regulation 4(a)(ii), 4(b) and (4(c) of the Licentiate
Regulations on several grounds, one of which is the lack of power
under the Act. The provisions extracted above would show that
NMC had the power to frame the above Regulations. Prescription
of minimum standards would certainly include the prescription of
the minimum duration for a course. It may be open to the medical
G institutions of other countries to prescribe a duration of less than
54 months for the students of their country. But it is not necessary
for the NMC and the Central Government to recognise foreign
medical degrees of a lesser duration, if the incumbent wants to
have permanent registration in India. The prescription of an
H internship for a minimum duration of 12 months in the same
ARAVINTH R.A. v. THE SECRETARY TO THE GOVERNMENT 923
OF INDIA MOH&FW

foreign medical institution cannot also be said to be a duplication A
of internships. The purpose of internship is to test the ability of
the students to apply their academic knowledge on their subjects,
namely the patients. Medical institutions of other countries may
not insist on rigorous internship for students who may not put to
test their skills on the population of their country. Similarly, the
B
requirement under Regulation 4(b) has been necessitated to
ensure that the students who were imparted medical education
in a foreign country demonstrate their skills first on the
population of the country where they studied. The necessity for a
Master Chef to taste the food prepared by him, before it is served
on the guests, cannot be said to be arbitrary. Therefore, the C
challenge to the Licentiate Regulations, are wholly without basis.
[Paras 51-54][942-C-H; 943-A]
2. The contention that Section 36(4) recognises M.B.B.S.
courses of a duration of less than 54 months and that therefore
the Licentiate Regulations being a subordinate legislation is ultra D
vires, is wholly unsustainable. All that sub-section (4) of Section
36 saves, are the qualifications already recognised before the date
of commencement of the Act and included in the Second Schedule
and Part-II of the Third Schedule to the 1956 Act. The fact that
past sins are sought to be washed away, is no ground to hold that
there cannot be a course correction. As a matter of fact, Section E
60 which deals with repeal and saving, also saves under clause
(b) of sub-section (2), any right, privilege or obligation already
acquired. This cannot be stated to be in conflict with what is
prescribed for the students of the future. In any case, Section 36
deals only with recognition of the foreign medical courses and F
not registration as medical practitioner. Registration is covered
by Section 33. Therefore, Section 36(4) cannot help the appellant.
[Para 55][943-A-D]
3. The contention that the country needs more doctors and
that by restricting the registration of foreign medical graduates, G
the fundamental right of the professionals under Article 19(1)(g)
and the fundamental right of the citizens under Article 21 are
impaired, is to be stated only to be rejected. It is true that the
country needs more doctors, but it needs really qualified doctors
and not persons trained by institutions abroad, to test their skills
only in their mother land. [Para 56][943-D-E] H
924 SUPREME COURT REPORTS [2022] 5 S.C.R.

A 4. The argument that these Regulations constitute an extra-
territorial law is misconceived. These Regulations do not
encroach into the sovereignty of the countries where those
institutions are located, by stipulating minimum standards for
the students who want to practise there. These Regulations merely
prescribe the minimum standards to be fulfilled by those who study
B
in those institutions but who want to practise here in India. [Para
57][943-F]
5. Insofar as the challenge to the CRMI Regulations are
concerned, the same is without any substance. If there are
C institutions in some countries which offer primary medical
qualification without mandatory internship, the students are
supposed not to seek admissions in those institutions. The mad
rush to become qualified medical professionals, cannot drive them
to countries where short-cuts to success are offered. The
requirement under Para 2(a) of Schedule-II of these Regulations
D for foreign medical graduates to undergo internships at par with
Indian medical graduates is to ensure that only those who have
acquired similar skills are allowed to practice Medicine. The
prescription in para 2(c)(i) of Schedule-II of these Regulations
that such foreign medical graduates may be posted first in colleges
E which have been newly opened and have yet to be recognised, is
a prescription of necessity. All medical institutions of the country
are equipped to provide internships only to as many students as
their permitted intake may allow. Therefore, this Regulation is
intended to ensure that an undue burden is not cast upon the
already recognised institutions. [Paras 58 and 59][943-G-H]
F
Medical Council of India v. Indian Doctors from Russia
Welfare Associations & Ors. (2002) 3 SCC 696; Sanjeev
Gupta v. Union of India (2005) 1 SCC 45 : [2004] 6
Suppl. SCR 49; Medical Council of India v. J. Saai
Prasanna & Ors. (2011) 11 SCC 748; Modern Dental
G College and Research Centre & Ors. v. State of Madhya
Pradesh & Ors. (2016) 7 SCC 353 : [2016] 3 SCR 579
– referred to.

H
ARAVINTH R.A. v. THE SECRETARY TO THE GOVERNMENT 925
OF INDIA MOH&FW

The Registrar, Travancore- Cochin Medical Council and A
Ors. 2019 (4) SCT 224 (Kerala); Sadhiya Siyad v. State
of Kerala and Ors. 2021 (6) KLT 94 – referred to.
Case Law Reference
(2002) 3 SCC 696 referred to Para 29 B
[2004] 6 Suppl. SCR 49 referred to Para 30
(2011) 11 SCC 748 referred to Para 35
[2016] 3 SCR 579 referred to Para 40
C
CIVIL APPELLATE JURISDICTION: Civil Appeal Nos. 3585-
3586 of 2022.
From the Judgment and Order dated 24.02.2022 of the High Court
of Judicature at Madras in WP/3667/2022 & WP/3670/2022.
D
Gopal Sankaranarayanan, Sr. Adv., S. Santanam Swaminadhan,
Ms. Abhilasha Shrawat, Ms. Himani Thakur, Kartik Malhotra, Mrs. Aarthi
Rajan, Ms. Shivani VIS, Advs. for the Appellant.
The Judgment of the Court was delivered by
V. RAMASUBRAMANIAN, J. E

1. Aggrieved by the dismissal of his two writ petitions praying
respectively for, (i) a declaration that Regulations 4(a)(i), 4(a)(ii), 4(b)
& 4(c) of the National Medical Commission (Foreign Medical Graduate
Licentiate) Regulations 2021, hereinafter referred to as ‘the Licentiate
F
Regulations’; and (ii) a declaration that Schedule-II 2(a) and 2(c)(i) of
the National Medical Commission (Compulsory Rotating Medical
Internship) Regulations, 2021, (hereinafter referred to as “CRMI
Regulations”) both published on 18.11.2021, are ultra vires and violative
of Articles 14, 19(1)(g) and 21 of the Constitution, the writ petitioner
before the Madras High Court has come up with the above appeals. G
2. We have heard Mr. Gopal Sankaranarayanan, learned senior
counsel appearing for the appellant.

H
926 SUPREME COURT REPORTS [2022] 5 S.C.R.

A 3. The appellant completed his Higher Secondary education in
the year 2021 under the C.B.S.E. Scheme. According to him, he appeared
for NEET 2021 and obtained 55.443417 percentile score. His All India
NEET Rank was 68772. Therefore, he could not get admission to a
medical college of his choice in India.
B 4. Contending (i) that he wanted to join an Under Graduate Medical
Course in Anna Medical College, Mauritius; (ii) that due to the restrictions
on international travel during the pandemic, he was unable to join the
said Course during the academic year 2021-22; and (iii) that in the
meantime the National Medical Commission of India brought the
C Licentiate and CRMI Regulations, imposing heavy and arbitrary burden
upon students who want to pursue medical education abroad, the appellant
filed two writ petitions as aforesaid.

5. Finding that the impugned Regulations were issued with a view
to ensure minimum standards and that they are in no way ultra vires the
D Act or the Constitution, a Division Bench of the Madras High Court
dismissed the writ petitions. Holding that the appellant has not even made
an application for admission to any institution in a foreign country and
that therefore the writ petitions were nothing but a mis-adventure, the
High Court also imposed costs of Rs.25,000/- upon the appellant.
E Therefore, the appellant has come up with these appeals.

6. As indicated at the beginning, what was challenged by the
appellant before the High Court were some provisions of two different
sets of Regulations. The 1st set of Regulations namely, the Licentiate
Regulations were issued by the National Medical Commission in exercise
F
of the powers conferred by Section 57 read with sub-section (4) of
Section 15 of the National Medical Commission Act. The 2nd set of
Regulations, namely the CRMI Regulations were issued by the
Commission in exercise of the powers conferred by Section 57 read
with sub-section (1) of Section 24 of the Act.
G
7. For the purpose of easy reference, the Regulations that were
challenged by the appellant before the High Court of Madras are
presented in two tabular columns as follows:-

H
ARAVINTH R.A. v. THE SECRETARY TO THE GOVERNMENT 927
OF INDIA MOH&FW [V. RAMASUBRAMANIAN, J.]

NMC (FMGL) Regulations, 2021 (Licentiate Regulations) A

Regulation Provision

4.Grant of permanent No foreign medical graduate shall be granted permanent
registration to Foreign registration, unless he has–
Medical Graduate.- (a) (i) undergone a course leading to foreign medical
degree with minimum duration of fifty-four months;
(ii) undergone an internship for a minimum duration of
twelve months in the same foreign medical institution; B
… … …
(b) registered with the respective professional regulatory
body or otherwise, competent to grant license to practice
medicine in their respective jurisdiction of the country in
which the medical degree is awarded and at par with the
license to practice medicine given to citizen of that
country.
(c) undergone supervised internship in India for a
minimum of twelve months, after applying for the same to
the Commission; C
… … …

NMC (CRMI) Regulations, 2021

D

E

F

G
8. The challenge of the appellant to some provisions of the
Licentiate Regulations, 2021 was on the following grounds:-
(i) Regulations 4(a)(i), 4(a)(ii), 4(b) and 4(c) are violative of the
Right to Health, inherent in Article 21, as they tend to impair the right of
the citizens to obtain quality medical treatment; H
928 SUPREME COURT REPORTS [2022] 5 S.C.R.

A (ii) The impugned Regulations are issued in exercise of the powers
conferred by Section 15(4) read with Section 57 of the Act, but these
provisions do not confer any such power to frame rules and regulations
in respect of such matters;
(iii) The requirement of Regulation 4(a)(i) that the foreign medical
B course should be of a duration of 54 months, will limit the choice available
to students to select only those institutions which offer a course of a
duration of 54 months. In any case, Under Graduate Medical Course of
a duration of less than 54 months is already recognised in Section 36(4)
of the NMC Act.
C (iv) Regulation 4(a)(ii) which makes it mandatory for a foreign
medical graduate to undergo an internship for a minimum duration of 12
months in the same foreign medical institution and Regulation 4(b) which
requires that such a graduate should have registered with the respective
professional regulatory body of the country in which the degree was
awarded, are clear examples of making extra-territorial legislation;
D
(v) Regulation 4(c) which requires the foreign medical graduates
to undergo supervised internship in India for a minimum period of 12
months, causes undue hardship for the students, as they may have to
undergo two internships, one in the foreign land and another in the mother
land;
E
(vi) Regulation 4(b) encroaches into the immigration policy of
another country, in as much as it imposes an obligation upon the students
to get registered with the professional regulatory body competent to
grant licence to practice medicine in their respective jurisdiction;

F (vii) The impugned Regulations impose unreasonable restrictions
upon the right to practice medicine and they do not even serve public
interest, as the country needs more doctors;
(viii) Unreasonable restrictions imposed by these Regulations will
cause brain-drain from this country;
G (ix) The impugned Regulations tend to increase the average
duration of the entire curriculum up to the stage of registration as a
medical practitioner, to 8-9 years for a foreign medical graduate, though
it is just 5½ years for an Indian medical graduate. Since the system of
Modern Medicine or Allopathy is the same throughout the world and
since it cannot differ from country to country, the classification of students
H
ARAVINTH R.A. v. THE SECRETARY TO THE GOVERNMENT 929
OF INDIA MOH&FW [V. RAMASUBRAMANIAN, J.]

into two categories namely those who study in India and those who A
study abroad, is violative of Article 14.
9. The challenge of the appellant to the second set of Regulations
namely the CRMI Regulations, 2021, is on the following grounds:-
(i) Schedule II-Para 2(a)(i) requires all foreign medical graduates
to undergo internship at par with Indian medical graduates. But the B
Regulations do not treat foreign medical graduates at par with Indian
medical graduates. Therefore, there is dichotomy. There are several
countries such as Ukraine, Georgia, Nepal, Bangladesh, Armenia,
Philippines and Malaysia, which offer primary medical qualification
without mandatory internship. Medical institutions in countries like C
Mauritius offer to their foreign students, the option to do compulsory
rotating medical internship in the country of their origin. But Schedule-II
of the Regulations deprives the students of these opportunities;
(ii) Schedule-II Para 2(c)(i) allows foreign medical graduates to
be posted first in colleges which have been newly opened and have yet D
to be recognised. This will dissuade students from pursuing medical
education abroad, as their future will be a question mark.
10. But we do not think that any of the above grounds of challenge
are sustainable in law. The Regulations impugned by the appellant may
appear superficially to be rigorous or tough. But these Regulations are a E
product of, (i) past experience; and (ii) necessity of times. Experts in
the field of education believe (and justifiably so) that over ambitious
parents, hapless children, exploitative and unscrupulous (and sometimes
unlettered) founders of infrastructure-deficient educational institutions,
paralysed regulatory bodies and courts with misplaced sympathy, have
all contributed (not necessarily in the same order) to the commercialisation F
of education and the decline of standards in the field of education, in
general and medical education, in particular. We may be able to appreciate
this, if we have a look at the history of evolution of statutory measures
taken to regulate the recognition and registration of foreign medical
degrees in India. G
11. The problem of unrecognised institutions offering diplomas/
degrees in medicine and untrained individuals practising medicine, is not
new, but is a century old phenomenon in India. This can be seen from
the fact that the first attempt to regulate the grant of titles implying
qualifications in western medical science was made under the Indian
H
930 SUPREME COURT REPORTS [2022] 5 S.C.R.

A Medical Degrees Act, 1916, which is an Imperial Act. Though there
were Acts of the Local Council in the larger provinces of British India
such as Bombay, Bengal and Madras provinces, they were found to be
toothless. Therefore, the Statement of Objects and Reasons of the Indian
Medical Degrees Act, 1916 recorded:-
B “…It has been found that at present, diplomas are issued
by private institutions to untrained or insufficiently trained
persons, and that many of these diplomas are colourable
imitations of those issued by recognised Universities and
Corporations. The result is that recipients of such diplomas
are able to pose to the public as possessing qualifications
C in medicine and surgery which they do not possess…”
12. Subsequently, an Act to constitute a Medical Council in India
was enacted under the title Indian Medical Council Act, 1933. The
object of creation of a Medical Council in India, as stated in the preamble
of this Act, was to establish a uniform minimum standard higher
D qualification in Medicine for all the provinces. This Act divided the medical
qualifications into three categories namely, (i) those granted by medical
institutions in the States included in the First Schedule; (ii) those granted
by medical institutions in the States not included in the First Schedule;
and (iii) those granted by medical institutions outside those States.
E 13. The First Schedule to the 1933 Act included Indian Universities
and the Second Schedule included institutions in countries like United
Kingdom, Australia, Burma, Canada etc. It may be of interest to note
that Osmania University of Hyderabad was included in the Second
Schedule, as Hyderabad was not, at that point of time, a part of British
F India. Section 12 of the 1933 Act granted automatic recognition to the
medical qualifications obtained from the universities of the countries
included in the Second Schedule.
14. After India attained independence, the Indian Medical Council
Act, 1956 was passed and it came into force on 01.11.1958. This Act
G repealed the Indian Medical Council Act, 1933. This Act was intended
to provide for the reconstitution of the Medical Council of India and the
maintenance of a Medical Register for India and such other matters
connected therewith.
15. The Statement of Objects and Reasons shows that the Act
was intended, (i) to provide for the registration of the names of citizens
H
ARAVINTH R.A. v. THE SECRETARY TO THE GOVERNMENT 931
OF INDIA MOH&FW [V. RAMASUBRAMANIAN, J.]

of India who have obtained foreign medical qualifications, which were A
not recognised at that time; and (ii) to provide for the temporary
recognition of medical qualifications granted by medical institutions in
the countries outside India with which no scheme of reciprocity existed.
16. Section 11 of the 1956 Act contained provisions for the
recognition of medical qualifications granted by universities or medical B
institutions in India. The First Schedule to the Act contained the list of
universities and medical institutions in India, the medical qualifications
granted by which, were required to be recognised by Section 11(1).
Section 11(2) dealt with universities and medical institutions in India not
included in the First Schedule.
C
17. Section 12 contained provisions for the recognition of medical
qualifications granted by medical institutions in countries with which there
was a scheme of reciprocity. Such medical institutions were included in
the Second Schedule.
18. Section 13 provided for recognition of medical qualifications D
granted by medical institutions, which are not included in the First Schedule
or Second Schedule but included in the Third Schedule. The Third
Schedule itself comprised of two parts. It is Part-II of the Third Schedule
which contained a list of recognised medical qualifications granted by
medical institutions outside India, not included in the Second Schedule.
E
19. Sub-section (3) of Section 13 of the Indian Medical Council
Act, 1956 provided for the recognition of medical qualifications granted
by medical institutions outside India, which are included in Part-II of the
Third Schedule, subject to the condition that the enrolment of a person
possessing such qualifications, in the Medical Register, would be
conditional upon his being a citizen of India and his having undergone F
such practical training as may be required by the Rules and Regulations
in the country granting the qualification. If he has not undergone any
practical training in that country, he must undergo practical training as
may be prescribed under the Act.
20. The 1956 Act, as it was originally enacted, enabled the Central G
Government under Section 13(4), to amend Part-II of the Third Schedule,
after consulting the Medical Council of India, so as to include therein
any qualification granted by a medical institution outside India which is
not included in the Second Schedule.
H
932 SUPREME COURT REPORTS [2022] 5 S.C.R.

A 21. But the real headache for the 1956 Act started, when the
Government of India requested the MCI in the year 1981 to consider the
grant of recognition for medical courses in medical institutions in the
erstwhile U.S.S.R. The Medical Council examined the request and
submitted a report, after which certain institutions in the erstwhile
U.S.S.R. were recognised and included in the Second Schedule of the
B
Act.
22. After the disintegration of U.S.S.R., institutions with dubious
reputations mushroomed (perhaps showing the way forward for many
back home), forcing MCI to recommend in the year 1994, the de-
recognition of all the medical degrees of the erstwhile U.S.S.R. Though
C the students were sufficiently warned by MCI through advertisement
issued in August, 1997 and the Executive Committee took certain
decisions, those decisions were diluted by a high level committee in a
meeting held in November, 1998. Eventually, it was decided to undertake
a process of post-screening, for those coming back to India and a system
D of pre-screening was recommended for those desirous of taking
admission in medical institutions of those countries.
23. Challenging those decisions, writ petitions were filed in different
High Courts by persons who had undergone courses in Medicine in
medical colleges in the erstwhile U.S.S.R. The Delhi High Court took
E the lead and was the first to grant relief to the candidates. When the
matter reached this Court, certain suggestions were made and the General
Body of MCI met on 31.03.2000 and passed certain Resolutions.
24. In order to give effect to the Executive decisions, the
Government of India introduced a bill in March 2001 for the amendment
F of the 1956 Act. After the bill was passed, Section 13 of the Act got
amended. By this Amendment Act 34 of 2001, two provisos and an
Explanation were inserted under sub-section (4) of Section 13. In
addition, sub-sections (4A), (4B) & (4C) were also inserted under Section
13(4).

G 25. Sub-section (4A), (4B) and (4C) of Section 13 inserted by
Act 34 of 2001 read as follows:-
(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
H
ARAVINTH R.A. v. THE SECRETARY TO THE GOVERNMENT 933
OF INDIA MOH&FW [V. RAMASUBRAMANIAN, J.]

Government under sub-section (3),shall not be entitled to be A
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
B
recognised 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 C
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 D
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 E
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 F
to the medical qualifications referred to in section 14 for the
purposes of that section.
26. As seen from the aforesaid provisions, sub-sections (4A)&
(4B) of Section 13 operated in two different time zones, namely pre-
admission to the course and post-completion of the course. While Sub- G
section (4B) spoke about an eligibility certificate to be obtained by a
candidate before seeking admission to any medical institution in any
foreign country, sub-section (4A) spoke about a screening test in India,
the passing of which was necessary, to get enrolled on any Medical
Register.
H
934 SUPREME COURT REPORTS [2022] 5 S.C.R.

A 27. After the insertion of sub-sections (4A) and (4B), two sets of
Regulations were put in place. One was the “Eligibility Requirement for
taking admission in an undergraduate medical course in a Foreign Medical
Institution Regulations, 2002”, and another was “Screening Test
Regulations, 2002”.
B 28. Regulations 3 and 4 of the Screening Test Regulations, 2002
read as follows:-
“3. An Indian citizen or a person who has been granted Overseas
Citizenship of India possessing a primary medical qualification
awarded by any medical institution outside India who is desirous
C of getting provisional or permanent registration with the Medical
Council of India or any State Medical Council on or after
15.03.2002 shall have to qualify a screening test conducted by the
prescribed authority for that purpose as per the provisions of
section 13 of theAct:
Provided that a person seeking permanent registration shall not
D
have to qualify the screening test if he/ she had already qualified
the same before getting his/ her provisional registration.
4. Eligibility Criteria: No person shall be allowed to appear in the
screening test unless:

E (1)No persons shall be allowed to appear in screening test unless:he/
she is a Citizen of India or has been granted Overseas Citizenship
of India and possess any primary medical qualification, which is
confirmed by the Indian Embassy concerned, to be a recognized
qualification for enrolment as medical practitioner in the country
in which the institution awarding the said qualification is situated
F
(2) he/ she had obtained ‘Eligibility Certificate’ from the Medical
Council of India as per the ‘Eligibility Requirement for taking
admission in an undergraduate medical course in a Foreign
Medical Institution Regulations, 2002’. This requirement shall not
be necessary in respect of Indian citizens or Overseas Citizens of
G India who have acquired the medical qualifications from foreign
medical institutions or have obtained admission in foreign medical
institution before 15thMarch, 2002.
(3) He/She has studied for the medical course at the same institute
located abroad for the entire duration of the course from where
H he/she has obtained the degree.
ARAVINTH R.A. v. THE SECRETARY TO THE GOVERNMENT 935
OF INDIA MOH&FW [V. RAMASUBRAMANIAN, J.]

Provided in cases where Central Government is informed of A
condition of war, civil unrest, rebellion, internal war or any such
situation wherein life of Indian citizen is in distress and such
information has been received through the IndianEmbassy in that
country then the Council shall relax the requirement of obtaining
medical education: from the same institute located abroad in
B
respect of which communication has been received from the Indian
Embassy in that country.
(4) Provided further that a person seeking provisional or permanent
registration shall not have to qualify the Screening Test if he/she
holds an Undergraduate medical qualification from Australia/
Canada/New Zealand/United Kingdom/United States of America C
and the holder thereof also been awarded a Post Graduate medical
qualification in Australia/Canada/NewZealand/United Kingdom/
United States of America and has been recognized for enrolment
as medical practitioner in that country.”
29. Both the above sets of Regulations were notified by the MCI D
on 18.02.2002. The date from which the provisions of the Regulations
would take effect was prescribed as 15.03.2002. As a result, the appeals
arising out the decisions of the Delhi High Court and the Allahabad High
Court were disposed of by this Court by an order reported in Medical
Council of India vs. Indian Doctors from Russia Welfare E
Associations &Ors.1.
30. However, another round of litigation started, with the filing of
a batch of writ petitions on the file of this Court under Article 32 of the
Constitution, at the instance of students who joined the Course in 1994
or 1995 or 1996 or 1999 or 2000. The challenge of these petitioners was F
to the Screening Test Regulations, 2002. But by a judgment in Sanjeev
Gupta vs. Union of India2, this Court rejected the challenge.
31. In April 2010, the MCI was rocked by a shameful scam of
epic proportions, which led to the promulgation of the Indian Medical
Council (Amendment) Ordinance, 2010 on 15.05.2010 superseding the G
Indian Medical Council and appointing a Board of Governors. The
Ordinance was soon replaced by the 2010 Amendment Act. Subsequently,
extension of the supersession from time to time was made under the

1
(2002) 3 SCC 696
2
(2005) 1 SCC 45 H
936 SUPREME COURT REPORTS [2022] 5 S.C.R.

A Indian Medical Council (Amendment) Act, 2011, the Indian Medical
Council (Amendment) Act, 2012 and by two subsequent ordinances.
32. At about the same time when the MCI was embroiled in a
controversy, an amendment was made to Regulation 4 of the Screening
Test Regulations, 2002 with effect from 16.04.2010. The Amendment
B was to the effect that a foreign medical graduate should have completed
his entire medical course from the same institution located abroad, in
order to be eligible to appear for the Screening Test. On account of this
Amendment, students who pursued Under Graduate medical education
partly in one foreign country and partly in another foreign country were
disqualified to take the Screening Test.
C
33. Therefore, some of the students affected by the amendment
to the Screening Test Regulations filed a batch of writ petitions on the
file of the Delhi High Court assailing Regulation 4(3) of the Screening
Test Regulations 2002, as amended with effect from 16.04.2010, as ultra
vires the provisions of the Act. The Division Bench of the Delhi High
D Court, by a judgement dated 27.09.2013 passed in Rohit Naresh Agarwal
vs. Union of India3 declared Regulation 4(3) as amended by the 2010
Regulations to be ultra vires the Act, in view of the purported legislative
policy reflected in sub-sections (4A) and (4B) of Section 13 and the
extent of power available in Clause (ma) of Section 33.
E 34. The Medical Council of India filed Special Leave Petitions
against the said judgement of the Delhi High Court. After granting leave,
those petitions were dismissed on the ground that the decision of the
High Court in declaring Regulation 4(3) of the Screening Test Regulations
2002 as ultra vires, did not suffer from any error.
F 35. Immediately after the 2010 Amendment to the Screening Test
Regulations, but before the decision of the Delhi High Court in Rohit
Naresh Agarwal (supra), this court had an occasion to deal with the
case of students who completed the first two terms of an undergraduate
medical course in an unrecognised medical college in India, but completed
G the last term in a medical institution in Tanzania. The batch of students
comprised of (1) some, who were declined provisional registration and
who could not do internship in India, (2) some, who were granted
provisional registration, completed internship, but declined permanent
registration and (3) some, whose permanent registration was
3
H (2013) 204 DLT 401 (DB)
ARAVINTH R.A. v. THE SECRETARY TO THE GOVERNMENT 937
OF INDIA MOH&FW [V. RAMASUBRAMANIAN, J.]

subsequently cancelled. The High Court granted relief to all of them and A
the judgement of the High Court was under challenge before this Court.
By a judgement reported in Medical Council of India vs. J. Saai
Prasanna & Ors.4, this court affirmed the judgement of the Andhra
Pradesh High Court. While doing so, this court held that “so long as the
medical institution in a country outside India has granted a medical
B
qualification and that medical qualification is recognized for
enrolment as medical practitioner in that country, all that is required
for the purpose of enrolment in the medical Register in India is
qualifying in the Screening Test in India”.
36. More importantly, this Court held in paragraph 12 as follows:
C
“12. In the case of persons who obtained a medical
qualification in a medical institution outside India, the question
as to where the course of study was undergone is not relevant.
The course of study could be in that country or if the norms
of the Medical Council of that country so permitted, the course
of study could be partly in that country and partly in another D
country including India.Once that country recognises a
medical qualification granted by the institution in that country
for the purpose of enrolment as a medical practitioner in that
country, and such medical degree-holder passes the screening
test in India, the Medical Council of India cannot refuse to E
recognise such degree on the ground that the student did a
part of his study in an institution in India as a part of his
medical study programme for the foreign institution.”
37. Thus, every time when the Regulatory body attempted to plug
the loopholes and reform the system, which was exploited by a few, F
there was a challenge to the same and the irresistible temptation to
undertake an irresponsible research in the nuances of law, set them at
naught many times. Courts, sometimes, were swayed by sympathy to
the plight of a few students, little realising that the plight of the patients
who would go to them will hardly come to light and the impact such
decisions would have on the population would never be known. G
38. Be that as it may, the above developments shocked the
conscience of a few (at least a few), which led, in the year 2014, to the
constitution of a Group of Experts chaired by Dr. Ranjit Roy Chaudhury
4
(2011) 11 SCC 748. H
938 SUPREME COURT REPORTS [2022] 5 S.C.R.

A to study the Indian Medical Council Act, 1956 and make
recommendations to the Government to make the Medical Council of
India (MCI), modern and suited to the prevailing conditions.
39. The report of the said Group of Experts was subsequently
examined by the Parliamentary Standing Committee on Health & Family
B Welfare and they submitted a report known as 92nd Report. Further, a
four-member committee headed by the Vice Chairman, NITI Aayog
was constituted to examine all options for reforms in MCI and to suggest
a way forward. The Committee framed a draft “National Medical
Commission (NMC) Bill”.
C 40. In Modern Dental College and Research Centre & Ors.
vs. State of Madhya Pradesh & Ors.5, this Court directed the Central
Government to take action on the above recommendations. It was in the
light of such developments that the National Medical Commission Act,
2019 (hereinafter referred to as ‘NMC Act’) was passed.
D 41. The NMC Act provided for the constitution of a National
Medical Commission and the constitution of four autonomous boards,
each with a different mandate. The Act provided for the recognition of
medical qualifications granted by universities and institutions in India
under Section 35 and recognition of medical qualifications granted by
medical institutions outside India, under Section 36. Section 36 of the
E Act reads as follows:-
36. Recognition of medical qualifications granted by medical
institutions outside India.-
(1) Where an authority in any country outside India, which by the
F law of that country is entrusted with the recognition of medical
qualifications in that country, makes an application to the
Commission for granting recognition to such medical qualification
in India, the Commission may, subject to such verification as it
may deem necessary, either grant or refuse to grant recognition
to that medical qualification:
G
Provided that the Commission shall give a reasonable
opportunity of being heard to such authority before refusing to
grant such recognition.

H 5
(2016) 7 SCC353
ARAVINTH R.A. v. THE SECRETARY TO THE GOVERNMENT 939
OF INDIA MOH&FW [V. RAMASUBRAMANIAN, J.]

(2) A medical qualification which is granted recognition by A
the Commission under sub-section (1) shall be a recognised
medical qualification for the purposes of this Act, and such
qualification shall be listed and maintained by the Commission in
such manner as may be specified by the regulations.
(3) Where the Commission refuses to grant recognition to B
the medical qualification under sub-section (1), the authority
concerned may prefer an appeal to the Central Government against
such decision within thirty days of communication thereof.
(4) All medical qualifications which have been recognised
before the date of commencement of this Act and are included in C
the Second Schedule and Part II of the Third Schedule to the
Indian Medical Council Act, 1956 (102 of 1956), shall also be
recognised medical qualifications for the purposes of this Act,
and shall be listed and maintained by the Commission in such
manner as may be specified by the regulations.
D
42. Similarly, the Act also provided for withdrawal of recognition
granted to a medical qualification, granted by medical institutions in India
under Section 38 and the de-recognition of medical qualifications granted
by medical institutions outside India. There was also a special provision
in Section 40 for the grant of recognition to any medical qualification
granted by a medical institution in a country outside India, provided that E
medical practice by a person possessing such qualification would depend
upon his qualifying in the National Exit Test.
43. While Section 56 of the Act confers powers upon the Central
Government to make rules, Section 57 confers power upon the National
Medical Commission to make regulations. In order to ensure that the F
power of the Commission to frame regulations is very wide, sub-section
(2) of Section 57 lists out about 46 matters, in respect of which NMC
may make regulations.
44. It is in exercise of the power conferred by Section 57 read
with sub-section (4) of Section 15 that the Licentiate Regulations 2021 G
were issued. Section 15 provided for the conduct of the National Exit
Test. Sub-section (4) of Section 15 mandated that any person with a
foreign medical qualification shall have to qualify National Exit Test for
the purpose of obtaining licence to practice Medicine. Section 15(4)
reads as follows:-
H
940 SUPREME COURT REPORTS [2022] 5 S.C.R.

A “15. National Exit Test.- xxx xxxxxx
(4) Any person with a foreign medical qualification shall have to
qualify National Exit Test for the purpose of obtaining licence to
practice medicine as medical practitioner and for enrolment in the
State Register or the National Register, as the case may be, in
B such manner as may be specified by regulations.
xxx xxx xxx”
45. Clause (k) of sub-section (2) of Section 57 indicates that the
Regulations framed by NMC may deal with “the manner in which a
person with foreign medical qualification shall qualify National Exit
C Test under sub-section (4) of Section 15”.
46. At this stage we may take a small detour to point out that the
Kerala State Medical Council, without waiting for the Central
Government to clean up the MCI, took the lead and passed a Resolution
dated 20.10.2017, making it compulsory for all foreign medical graduates
D to complete one year internship in any institution within India approved
by MCI, for the grant of permanent registration in the State of Kerala
under the Travancore-Cochin Medical Practitioners Act, 1953. On the
basis of the said Resolution, the application for permanent registration of
some foreign medical graduates were rejected and the rejection became
E the subject matter of challenge in Dr. Amala Girijan and Ors. vs. The
egistrar, Travancore-Cochin Medical Council and Ors. 6 The
challenge was on the ground that the Resolution of the State Medical
Council was in violation of Section 37 of the State Act. However, the
challenge was rejected by a learned Judge of the Kerala High Court.

F 47. But subsequently, the same Resolution came to be challenged
by another foreign medical graduate in Sadhiya Siyad vs. State of Kerala
and Ors.7 Another learned Judge of the Kerala High Court before whom
the writ petitions came up, framed the following four questions as arising
for consideration:-
“(i) Whether a person who has not undergone internship as
G
part of the medical course undertaken by him/her abroad is eligible
to appear in the Screening Test provided for under Section 13(4A)
of the IMC Act?

6
2019 (4) SCT 224 (Kerala)
7
H 2021 (6) KLT 94
ARAVINTH R.A. v. THE SECRETARY TO THE GOVERNMENT 941
OF INDIA MOH&FW [V. RAMASUBRAMANIAN, J.]

(ii) Whether a person who obtains Eligibility Certificate in A
terms of Section 13(4B) of the IMC Act after taking admission in
a medical institution abroad, be denied enrolment on a State
Medical Register, if he/she satisfies all other eligibility criteria for
the same?
(iii) Whether a person who obtains a medical qualification B
from a medical institution abroad and undertakes one year
internship thereafter in the country of education and satisfies all
other eligibility criteria for enrolment on a State Medical Register
be insisted to undergo CRRI for the said purpose?
(iv) Whether the State Medical Council functioning under C
the TCMP Act is empowered to take decisions in the nature of
Ext. P21?”
48. The Kerala High Court held, (i) that the stand of the State
Medical Council that only students who have completed internship as
part of the medical course undertaken by them in the medical institutions D
abroad, are entitled to appear for the Screening Test, is unsustainable;
(ii) that if a candidate satisfied all the requirements for enrolling as a
medical practitioner on a State Medical Register in accordance with the
provisions of the 1956 Act and the Regulations made there under, he
cannot be denied registration by a State Medical Council; (iii) that if a
candidate satisfied all the requirements for enrolling as a medical E
practitioner on a State Medical Register in accordance with the provisions
of the 1956 Act and the regulations made there under, the State Medical
Council cannot deny enrolment on the ground that the candidate had
obtained Eligibility Certificate after taking admission to the medical
institution abroad and was consequently not eligible to appear for F
Screening Test; (iv) the requirement stipulated by the Kerala State
Medical Council that such foreign medical graduates should undergo
CRRI for claiming permanent registration, is inconsistent with the
requirements of the 1956 Act and the Regulations; and (v) that since the
1956 Act is relatable to Entry 66 of List-I of the Seventh Schedule of the
Constitution, it would prevail over the Kerala enactment relatable to G
Entry 25/26 of List-III.
49. Though the High Court of Kerala allowed the writ petition
filed by Sadhiya Siyad, it was made clear in the said Judgment that the
same would not preclude the State Medical Council from bringing to the
H
942 SUPREME COURT REPORTS [2022] 5 S.C.R.

A notice of the NMC, the requirement if any, for the foreign medical
graduates to undergo internship afresh to get acclimatised with the
diseases and requirements of treatment peculiar to the State in order to
bring in force, the appropriate statutory amendments.
50. Thus, a stage was set for the NMC to issue appropriate
B regulations in exercise of the power conferred by Section 57 of the Act.
Accordingly, the Licentiate Regulations were issued in exercise of the
power conferred by Section 15(4) read with Section 57 and the CRMI
Regulations were issued in exercise of the power conferred by Section
24(1) read with Section 57 of the Act. Keeping these developments in
mind, let us now test the validity of the grounds of challenge to these
C Regulations.
51. As we have seen earlier, the appellant challenged the validity
of Regulation 4(a)(i) and Regulation 4(a)(ii), 4(b) and (4(c) of the
Licentiate Regulations on several grounds, one of which is the lack of
power under the Act. But the provisions extracted above would show
D that NMC had the power to frame the above Regulations.
52. Prescription of minimum standards would certainly include
the prescription of the minimum duration for a course. It may be open to
the medical institutions of other countries to prescribe a duration of less
than 54 months for the students of their country. But it is not necessary
E for the NMC and the Central Government to recognise foreign medical
degrees of a lesser duration, if the incumbent wants to have permanent
registration in India.
53. The prescription of an internship for a minimum duration of 12
months in the same foreign medical institution cannot also be said to be
F a duplication of internships. The purpose of internship is to test the ability
of the students to apply their academic knowledge on their subjects,
namely the patients. Medical institutions of other countries may not insist
on rigorous internship for students who may not put to test their skills on
the population of their country. But it is not necessary for us to follow
G suit.
54. Similarly, the requirement under Regulation 4(b) has been
necessitated to ensure that the students who were imparted medical
education in a foreign country demonstrate their skills first on the
population of the country where they studied. The necessity for a Master
Chef to taste the food prepared by him, before it is served on the guests,
H
ARAVINTH R.A. v. THE SECRETARY TO THE GOVERNMENT 943
OF INDIA MOH&FW [V. RAMASUBRAMANIAN, J.]

cannot be said to be arbitrary. Therefore, the challenge to the Licentiate A
Regulations, are wholly without basis.
55. The contention that Section 36(4) recognises M.B.B.S. courses
of a duration of less than 54 months and that therefore the Licentiate
Regulations being a subordinate legislation is ultra vires, is wholly
unsustainable. All that sub-section (4) of Section 36 saves, are the B
qualifications already recognised before the date of commencement of
the Act and included in the Second Schedule and Part-II of the Third
Schedule to the 1956 Act. The fact that past sins are sought to be washed
away, is no ground to hold that there cannot be a course correction. As
a matter of fact, Section 60 which deals with repeal and saving, also
saves under clause (b) of sub-section (2), any right, privilege or obligation C
already acquired. This cannot be stated to be in conflict with what is
prescribed for the students of the future. In any case, Section 36 deals
only with recognition of the foreign medical courses and not registration
as medical practitioner. Registration is covered by Section 33. Therefore,
Section 36(4) cannot help the appellant. D
56. The contention that the country needs more doctors and that
by restricting the registration of foreign medical graduates, the
fundamental right of the professionals under Article 19(1)(g) and the
fundamental right of the citizens under Article 21 are impaired, is to be
stated only to be rejected. It is true that the country needs more doctors, E
but it needs really qualified doctors and not persons trained by institutions
abroad, to test their skills only in their mother land.
57. The argument that these Regulations constitute an extra-
territorial law is misconceived. These Regulations do not encroach into
the sovereignty of the countries where those institutions are located, by F
stipulating minimum standards for the students who want to practise
there. These Regulations merely prescribe the minimum standards to be
fulfilled by those who study in those institutions but who want to practise
here in India.
58. Insofar as the challenge to the CRMI Regulations are G
concerned, the same is without any substance. If there are institutions in
some countries which offer primary medical qualification without
mandatory internship, the students are supposed not to seek admissions
in those institutions. The mad rush to become qualified medical
professionals, cannot drive them to countries where short-cuts to success
H
944 SUPREME COURT REPORTS [2022] 5 S.C.R.

A are offered. The requirement under Para 2(a) of Schedule-II of these
Regulations for foreign medical graduates to undergo internships at par
with Indian medical graduates is to ensure that only those who have
acquired similar skills are allowed to practice Medicine.
59. The prescription in para 2(c)(i) of Schedule-II of these
B Regulations that such foreign medical graduates may be posted first in
colleges which have been newly opened and have yet to be recognised,
is a prescription of necessity. All medical institutions of the country are
equipped to provide internships only to as many students as their permitted
intake may allow. Therefore, this Regulation is intended to ensure that
an undue burden is not cast upon the already recognised institutions.
C
60. Therefore, we find that the dismissal of the writ petitions filed
by the appellant before the Madras High Court was fully justified. We
could have dismissed the SLPs in limine, but we thought fit to take pains
to bring on record the historical facts so that the challenge to these
Regulations are nipped in the bud and they do not surface in a different
D form or avatar.
61. In view of the above, the appeals are dismissed. However,
the costs imposed by the High Court of Madras upon the appellant is
waived off, taking into account of the fact that he is a student and also
for the purpose of showing the only extent to which, a court can show
E sympathy in such matters.

Devika Gujral Appeals dismissed.
(Assisted by : Mahendra Yadav, LCRA)

F

G

H