MEDICAL COUNCIL OF INDIAversusVEDANTAA INSTITUTE OF ACADEMIC EXCELLENCE PVT. LTD. AND ORS.

                           [2018] 5 S.C.R. 1                               1


                  MEDICAL COUNCIL OF INDIA                                 A
                                   v.
VEDANTAA INSTITUTE OF ACADEMIC EXCELLENCE PVT.
                 LTD. AND ORS.
                   (Civil Appeal No. 5805 of 2018)                         B
                        JUNE 01, 2018
                 [L. NAGESWARA RAO AND
          MOHAN M. SHANTANAGOUDAR, JJ.]
      Education/Educational Institutions:
                                                                           C
        Establishment of Medical College Regulations, 1999 – Regn.
8(3)(1)(a) – Medical education – Inspection conducted for granting
first renewal for admission of students for academic year 2018-19
– Several deficiencies pointed out – Writ petition by Medical Institute
seeking direction to Medical Council of India-MCI to send its Expert
team for verifying the compliance of deficiencies pointed out and          D
to forward its recommendation to Central Government; and Union
of India to consider grant of renewal permission – High Court issued
direction to MCI to inspect the Medical College and submit a report
to Union of India – On appeal, held: Medical education must be
taken very seriously and when an expert body certifies that the
                                                                           E
facilities in a medical College are inadequate, it is not for the Courts
to interfere with the assessment, except for very cogent jurisdictional
reasons such as mala fides of the inspection team, ex facie perversity
in the inspection, jurisdictional error on the part of the MCI – On
facts, High Court erred in holding that Regn. 8(3)(1)(a) would be
applicable only to Colleges seeking second renewal – Admissions            F
upto second renewal would fall u/Regn. 8(3)(1)(a) – Proviso not
restricted only to second renewal cases – Even the first renewal is
covered by proviso (a) to Regn. 8(3)(1) as the language used is
“upto second renewal” – Further, the Regn. 8(3)(1) provides that
an opportunity shall be given to the medical College to rectify the
                                                                           G
defects but, the proviso contemplates that certain minimum standards
are to be satisfied – This prescription of standards for availing an
opportunity to seek re-inspection not ultra vires either the Regulation
or s. 10-A – Thus, in view of the large scale deficiencies found in
the inspection reports and in view of Regn. 8(3)(1)(a), medical
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                                   1
2            SUPREME COURT REPORTS                       [2018] 5 S.C.R.


A   college not entitled to claim another inspection – Medical Council
    Act, 1956.
          Allowing the appeal, the Court
           HELD: 1.1 Though Regulation 8 (3)(1)(a) of the
    Establishment of Medical College Regulations, 1999 was
B   challenged in the writ petition filed by respondent No.1 and 2,
    they did not press the relief. They restricted their challenge to
    the manner in which the inspection was done and for a direction
    to the appellant-Council to carry out a fresh inspection. The
    interpretation of Regulation 8 (3) (1) (a) by the High Court is
C   patently erroneous in as much as the High Court did not take
    note of the proviso to Regulation 8(3)(1). Without a proper
    examination of the provision, the High Court fell in error in holding
    that Regulation 8 (3) (1) (a) would be applicable only to the
    Colleges seeking second renewal i.e. admissions of the third
    batch. Admissions upto the second renewal i.e. admissions to
D   third batch would fall under Regulation 8 (3) (1) (a). In other words,
    the proviso is not restricted only to second renewal cases. Even
    the first renewal is covered by proviso (a) to Regulation 8 (3) (1)
    as the language used is “upto second renewal”. There is no
    conflict between Section 10-A (3) and (4) of the Act on one hand
E   and Regulation 8 (3) (1) (a) on the other. Regulation 8 (3) (1) (a)
    is complementary to Section 10-A of the Act. Fixing minimum
    standards which have to be fulfilled for the purpose of enabling a
    medical College to seek fresh inspection would not be contrary
    to the scheme of Section 10-A. In fact, Regulation 8 (3) (1)
    provides that an opportunity shall be given to the medical College
F   to rectify the defects. But, the proviso contemplates that certain
    minimum standards are to be satisfied i.e. there should not be
    deficiency of teaching faculty and/or residents more than 30 per
    cent and/or bed occupancy should not be less than 50 per cent.
    This prescription of standards for availing an opportunity to seek
G   re-inspection is not ultra vires either the Regulation or Section
    10-A of the Act. [Para 9][10-B-F]
          1.2 On perusal of the material on record, the conclusion
    reached by the High Court regarding the manner in which
    inspection was conducted is also not correct. Bed occupancy at
H   45.30 per cent on random verification was the claim of respondent
   MEDICAL COUNCIL OF INDIA v. VEDANTAA INSTITUTE OF                    3
            ACADEMIC EXCELLENCE PVT. LTD.

No.1 and 2. However, the inspection report shows that out of            A
required minimum of 300 patients only 3 were available at 10.00
am on 25th September, 2017. Medical education must be taken
very seriously and when an expert body certifies that the facilities
in a medical College are inadequate, it is not for the Courts to
interfere with the assessment, except for very cogent
                                                                        B
jurisdictional reasons such as mala fides of the inspection team,
ex facie perversity in the inspection, jurisdictional error on the
part of the M.C.I., etc. The submission relating to the cyclone
being a reason for the number of patients being less is not
acceptable. It is accepted that the Resident Doctors are required
to be in the hospital at all points of time. [Para 10][10-G-H; 11-A-    C
B]
      1.3 In view of the large scale deficiencies found in the
inspection reports and in view of Regulation 8 (3) (1) (a), the
respondent No.1 and 2 are not entitled to claim another
inspection. The judgment of the High Court is set aside. [Paras         D
11, 12][11-C-D]
      Medical Council of India v. Kalinga Institute of Medical
      Sciences (KIMS) & Ors. (2016) 11 SCC 530 : [2016] 4
      SCR 403; Royal Medical Trust (Registered) v. Union
      of India (2015) 10 SCC 19 – referred to.                          E
                       Case Law Reference
      [2016] 4 SCR 403                 referred to     Para 6
      (2015) 10 SCC 19                 referred to     Para 8
      CIVIL APPELLATE JURISDICTION: Civil Appeal No. 5805               F
of 2018.
      From the Order dated 20.04.2018 of the High Court of Judicature
at Bombay in WP No. 4319 of 2018.
    Vikas Singh, Sr. Advocate, Gaurav Sharma, Prateek Bhatia,
Dhawal Mohan and Mrs. Depika Kalia, Advs., for the appellant.           G

      Maninder Singh, ASG, Ranjit Kumar, Sr. Advocate, Sudhanshu S.
Choudhari, V. M. Thorat, Shakul R. Ghatole, Amarjeet Singh, Ms. Vimal
Sinha, Pranay Ranjan and Gurmeet Singh Makker, Advs., for the
respondents.
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4             SUPREME COURT REPORTS                           [2018] 5 S.C.R.


A         The Judgment of the Court was delivered by
          L. NAGESWARA RAO, J. Leave granted.
           1. Vedantaa Institute of Academic Excellence Pvt. Ltd. and
    Vedantaa Institute of Medical Sciences, Respondent Nos.1 and 2 herein
    filed Writ Petition No.4319 of 2018 in the High Court of Judicature at
B   Bombay seeking a direction to the Appellant to send its Experts’ team for
    the purpose of verifying the compliance of the deficiencies pointed out
    earlier. They also prayed for a direction to the Appellant
                                                          th
                                                               to forward its
    recommendation to the Central Government before 30 April, 2018. They
    sought a further direction to Respondent No.3 herein, Union of India to
C   consider the grant of renewal permission on the basis of the
    recommendations received from the Appellant. The High Court allowed
    the Writ Petition and directed the Medical Council of India to inspect
    Respondent No.2, Medical College and submit a report to the Union of
    India before 30th April, 2018. Aggrieved thereby, the Appellant Council
    has filed the above appeal.
D
           2. Respondent No.1 submitted an application under Section 10-A
    of the Indian Medical Council Act, 1956 (hereinafter referred to as the
    ‘Act’) for starting a Medical College. A letter of intent was issued to
    Respondent No.1 after conducting an inspection. The Union of India
    issued a letter of permission dated 31.05.2017 to Respondent No.1 to
E   admit the first batch of 150 students for the academic year 2017-2018.
    After issuance of a letter of permission, the Respondent No.2 College
    was included in the list of Colleges for centralised process of admission
    carried out by the State of Maharashtra. Students were allotted for the
    year 2017-2018 in the centralised counselling. The inspection for the
F   purpose of granting first renewal for admission of students for the academic
    year 2018-2019 was conducted on 25.09.2017 and 26.09.2017. The
    Executive Committee of the Appellant Council considered the assessment
    report in its meeting held on 25.10.2017 and it was decided as under:-
          “The Executive Committee of the Council considered the
G         assessment report (25/26.09.2017) and noted the following:-
             1. Deficiency of faculty is 84.05% as detailed in the report.
             2. Shortfall of Residents is 87.23% as detailed in the report.
             3. Pathology, Microbiology, Pharmacology, Forensic Medicine,
             Community Medicine departments are under construction
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 MEDICAL COUNCIL OF INDIA v. VEDANTAA INSTITUTE OF                    5
ACADEMIC EXCELLENCE PVT. LTD. [L. NAGESWARA RAO, J.]

    4. Bed Occupancy is 01% at 10 a.m. on day of assessment.          A
    5. Wards: Majority of the wards were locked or under renovation
    and non-functional.
    6. Data of OPD attendance, Radiological & laboratory
    investigations are inflated.
                                                                      B
    7. There was NIL Major, NIL Minor & NIL Daycare Operation
    on day of assessment.
    8. There was NIL woman in Labour room.
    9. Nursing staff: 164 Nursing staff are available against
    requirement of 175.                                               C
    10. Paramedical & Non-teaching staff: 90 Paramedical & Non-
    teaching staff are available against requirement of 100.
    11. MRD: There is no MRD Office.
    12. O.T.: Non of O.T. was functional on day of assessment         D
    13. ICU: There was NIL patient in ICCU & all ICUs on day of
    assessment.
    14. 1 Mobile X-ray machine is available against requirement
    of 2.
                                                                      E
    15. Blood Bank is not functional.
    16. Kitchen is not functional.
    17. Examination hall: It is under construction.
    18. Central Library: Librarian is not available.
                                                                      F
    19. Central Photography section: There is no staff.
    20. Students’ Hostels: Available accommodation is for 128
    students against requirement of 226.
    21. Residential quarters: 18 quarters are available for faculty   G
    against requirement of 20. 16 quarters are available for non-
    teaching staff against requirement of 32.
    22. RHTC: It is not yet allotted.
    23. UHC: It is not yet allotted.
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6            SUPREME COURT REPORTS                           [2018] 5 S.C.R.


A           24. There is no CME activity during the year.
            25. Other deficiencies as pointed out in the assessment report.
          The Executive Committee noted that Regulation 8(3)(1)(a) of the
          Establishment of Medical College Regulation (Amendment), 2010
          (Part II), dated 16th April, 2010 and amended on 18 th March,
B         2016 provided as under:-
          “8(3)(1)…..
          (a) Colleges in the stage of Letter of Permission upto II renewal
          (i.e. Admission of third batch)
C         It is observed during any inspection/assessment of the institute
          that the deficiency of teaching faculty and/or Residents is more
          than 30% and/or bed occupancy is <50% (45% in North East,
          Hilly terrain etc.), compliance of rectification of deficiencies from
          such an institute will not be considered for issue of Letter of
D         Permission (LOP)/ renewal of permission in that Academic Year.”
          In view of the deficiencies as noted above, the Executive
          Committee of the Council decided to recommend to the Central
          Govt. to invoke Regulation 8 (3)(1)(a) of the Establishment of
          Medical College Regulation, 1999 and disapprove the application
          of the Vedantaa Institute of Medical Sciences, Palghar,
E
          Maharashtra under Maharashtra University of Health Sciences
          Nashik u/s 10A of the IMC Act, 1956 for renewal of permission
          of MBBS course 2nd batch (150 seats) for the academic year
          2018-2019.”
           3. The said decision of the Executive Committee was approved
F
    by the Oversight Committee on 16.11.2017. The Appellant by a letter
    dated 21.11.2017 communicated the decision of the Executive Committee
    as approved by the Oversight Committee to the Union of India. By a
    letter dated 07.12.2017, the Respondent No. 3, Union of India directed
    the Respondent College to respond to the recommendation of the
G   Appellant. A detailed reply was submitted by the College and even a
    personal hearing was given.
         4. The High Court allowed the Writ Petition filed by Respondent
    No.1 and 2 mainly on two grounds. According to the High Court,
    Regulation 8 (3) (1) proviso (a) of the Establishment of Medical College
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  MEDICAL COUNCIL OF INDIA v. VEDANTAA INSTITUTE OF                            7
 ACADEMIC EXCELLENCE PVT. LTD. [L. NAGESWARA RAO, J.]

Regulations, 1999 (hereinafter referred to as the Regulations) is not          A
applicable to the case of Respondent No.1 and 2. The relevant portion of
Clause 8 (3) (1) is extracted as under:-
      “8 GRANT OF PERMISSION:
      (3)(1). The permission to establish a medical College and admit          B
      students may be granted initially for a period of one year and
      may be renewed on yearly basis subject to verification of the
      achievements of annual targets. It shall be the responsibility of
      the person to apply to the Medical Council of India for purpose
      of renewal six months prior to the expiry of the initial permission.
      This process of renewal of permission will continue till such            C
      time the establishment of the medical College and expansion of
      the hospital facilities are completed and a formal recognition of
      the medical College is granted. Further admissions shall not
      be made at any stage unless the requirements of the Council
      are fulfilled. The Central Government may at any stage convey            D
      the deficiencies to the applicant and provide him an opportunity
      and time to rectify the deficiencies.
      Note: In above clause, “six months” shall be substituted by “as
      per latest time schedule”
      PROVIDED that in respect of a) Colleges in the stage of                  E
      Letter of Permission upto II renewal (i.e. admission of third
      batch)
      If it is observed during any inspection/assessment of the institute
      that the deficiency of teaching faculty and/or Residents is more
      than 30% and/or bed occupancy is <50% (45% in North East,                F
      Hilly terrain, etc.), compliance of rectification of deficiencies from
      such an institute will not be considered for issue of Letter of
      Permission (LOP)/renewal of permission in that Academic Year.”
       5. The other point which found favour with the High Court is the
manner in which the inspection was conducted. The High Court held              G
that the inspection conducted by the Assessors was not fair.
     6. Mr. Vikas Singh, learned Senior Counsel appearing for the
Appellant submitted that findings recorded by the High Court that

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8               SUPREME COURT REPORTS                          [2018] 5 S.C.R.


A   Regulation 8 (3) (1) is not applicable to the Respondent College as it had
    sought for first renewal is clearly erroneous. He submitted that the High
    Court lost sight of the first proviso to Regulation 8 (3) (1). He contended
    that there is no ambiguity in the language of the first proviso to Regulation
    8 (3) (1) which covers Colleges upto the second renewal. According to
    the said Regulation, Institutions having deficiency of teaching faculty
B
    and/or residents more than 30 per cent and/or bed occupancy less than
    50 per cent will not be considered for renewal of permission for that
    academic year. In view of the large scale deficiencies found in the
    inspection conducted on 25.09.2017 and 26.09.2017, Mr. Singh submits
    that there is no question of an opportunity being given to Respondent
C   No.1 to rectify the deficiencies. He also urged that the inspection was
    done strictly in accordance with the Assessors’ Guide issued by the
    Medical Council of India. He pointed out that the general instructions
    issued to the Assessors clearly shows that it was mandatory to verify
    the attendance sheet of every department (completed before 11.00 am),
    signed by the faculty present on the day of assessment and duly counter-
D
    signed by the Head of Department. According to the Assessors’ Guide
    the institutions should be asked to submit daily average clinical data for
    the last 12 months and clinical data of the first day of assessment. Bed
    occupancy was to be verified at 10.00 am, whereas OPD, Laboratory
    and Radiological Investigation data etc. are to be verified at 2.00 pm on
E   the first day of assessment. In respect of verification of teaching faculty
    and resident doctors, the Assessors’ Guide provides for checking of
    faculty attendance before 11.00 am on the first day of assessment. Only
    faculty/residents who signed the attendance sheet before 11.00 am are
    to be verified. No verification should be done for the faculty/residents
    coming after 11.00 am. Mr. Vikas Singh, learned Senior Counsel took us
F
    through the inspection notes to submit that the inspection done by the
    assessment team cannot be found fault with. He also relies upon the
    judgment of this Court in Medical Council of 1India v. Kalinga
    Institute of Medical Sciences (KIMS) & Ors. , to state that the
    report of the Experts should not be interfered with by this Court.
G
           7. Mr. Maninder Singh, learned Additional Solicitor General,
    appearing for the Union of India submitted that the provisos to Regulation
    8 (3) (1) was inserted with a view to ensure that Institutions which do
    not satisfy the minimum infrastructure and faculty cannot to be given an
    1
        (2016) 11 SCC 530- Para 24
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     MEDICAL COUNCIL OF INDIA v. VEDANTAA INSTITUTE OF                           9
    ACADEMIC EXCELLENCE PVT. LTD. [L. NAGESWARA RAO, J.]

opportunity to rectify their defects. According to him, the standards fixed      A
by the Medical Council of India are the bare minimum and have to be
strictly complied with to ensure the maintenance of basic minimum
standards of medical education. Any lenience shown by this Court in
providing an opportunity to such Institutions to rectify the defects will have
a cascading effect in the succeeding years and would result in Colleges
                                                                                 B
continuing to function with deficiencies as well as producing half baked
and poor quality doctors. He showed us the predictions made by the
Meteorological Department from 20th September, 2017 to 26th September,
2017. He submitted that thunderstorm and heavy rain is common in coastal
areas and the situation was not as dangerous as projected by Respondent
No.1 and 2. He further submitted that the minimum requirement of faculty         C
and residents is 70 per cent. He stated that if 70 per cent of the strength
of residence had to be present in the hospital on 24.09.2017 (i.e. the
previous day of inspection), it is inconceivable that there could be shortage
of 84 per cent teachers and 87 per cent of residents on the date of
inspection. He also stated that a natural calamity like cyclone would result
                                                                                 D
in increase in the number of patients.
       8. Mr. Ranjit Kumar, learned Senior Counsel appearing for the
Respondent No.1 and 2 supported the judgment of the High Court. He
relied upon the judgment of this   2
                                       Court in Royal Medical Trust
(Registered) v. Union of India to support his submission that an
opportunity has to be given to a Medical Institute to rectify the                E
deficiencies. He countered the submission of learned Senior Counsel
for the Medical Council of India by submitting that the Regulations cannot
over-ride the statute. According to him, Section 10-A as interpreted by
this Court entitles the Respondent College to be provided with an
opportunity to cure the defects pointed out during the inspection. Such          F
provision cannot be over ridden by a Regulation. He relied upon the
prediction of cyclone whereby the people of the locality were asked to
stay indoors. He contended that a request was made to the team of
Assessors to have another assessment on the same day. He further
submitted that the inspection was not conducted in a fair manner and the
report does not represent the correct picture. If another inspection is          G
done by the Medical Council of India to verify the facilities available in
the hospital and the College, the College would be able to satisfy the
requirements. He relied upon the decision taken by the Medical Council
2
    (2015) 10 SCC 19 paras 26-31
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10             SUPREME COURT REPORTS                              [2018] 5 S.C.R.


A    of India in directing fresh inspection to be conducted in respect of a few
     Colleges where the deficiencies were more than the minimum prescribed
     in Regulation 8 (3) (1) (a). In reply to the submissions of Mr. Ranjit
     Kumar on this point Mr. Vikas Singh stated that a second inspection was
     permitted to be done only in respect of Government Medical Colleges.
B           9. Though Regulation 8 (3) (1) (a) was challenged in the Writ
     Petition filed by Respondent No.1 and 2, they did not press the relief.
     They restricted their challenge to the manner in which the inspection was
     done and for a direction to the Appellant-Council to carry out a fresh
     inspection. The interpretation of Regulation 8 (1) (a) by the High Court
     is patently erroneous in as much as the High Court did not take note of
C    the proviso to Regulation 8(3)(1). Without a proper examination of the
     provision, the High Court fell in error in holding that Regulation 8 (3) (1) (a)
     would be applicable only to the Colleges seeking second renewal i.e.
     admissions of the third batch. Admissions upto the second renewal i.e.
     admissions to third batch would fall under Regulation 8 (3) (1) (a). In
D    other words, the proviso is not restricted only to second renewal cases.
     Even the first renewal is covered by proviso (a) to Regulation 8 (3) (1)
     as the language used is “upto second renewal”. We do not see any
     conflict between Section 10-A (3) and (4) of the Act on one hand and
     Regulation 8 (3) (1) (a) on the other. Regulation 8 (3) (1) (a) is
     complementary to Section 10-A of the Act. Fixing minimum standards
E    which have to be fulfilled for the purpose of enabling a medical College
     to seek fresh inspection would not be contrary to the scheme of Section
     10-A. In fact, Regulation 8 (3) (1) provides that an opportunity shall be
     given to the medical College to rectify the defects. But, the proviso
     contemplates that certain minimum standards are to be satisfied i.e. there
F    should not be deficiency of teaching faculty and/or residents more than
     30 per cent and/or bed occupancy should not be less than 50 per cent.
     This prescription of standards for availing an opportunity to seek re-
     inspection is not ultra vires either the Regulation or Section 10-A of the
     Act.
G           10. On perusal of the material on record, we are of the opinion
     that the conclusion reached by the High Court regarding the manner in
     which inspection was conducted is also not correct. Bed occupancy at
     45.30 per cent on random verification was the claim of Respondent
     No.1 and 2. However, the inspection report shows that out of required
     minimum of 300 patients only 3 were available at 10.00 am on 25th
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   MEDICAL COUNCIL OF INDIA v. VEDANTAA INSTITUTE OF                             11
  ACADEMIC EXCELLENCE PVT. LTD. [L. NAGESWARA RAO, J.]

September, 2017. This Court in Kalinga (supra) has held that medical             A
education must be taken very seriously and when an expert body certifies
that the facilities in a medical College are inadequate, it is not for the
Courts to interfere with the assessment, except for very cogent
jurisdictional reasons such as mala fides of the inspection team, ex facie
perversity in the inspection, jurisdictional error on the part of the M.C.I.,
                                                                                 B
etc. The submission relating to the cyclone being a reason for the number
of patients being less is not acceptable. We are in agreement with the
submission made on behalf of the Appellant that the Resident Doctors
are required to be in the hospital at all points of time.
       11. In view of the large scale deficiencies found in the inspection
report dated 25.09.2017 and 26.09.2017 and in view of Regulation 8 (3)           C
(1) (a), the Respondent No.1 and 2 are not entitled to claim another
inspection.
      12. For the aforementioned reasons, the judgment of the High
Court is set aside and the Appeal is allowed.
                                                                                 D

Nidhi Jain                                                     Appeal allowed.




                                                                                 E




                                                                                 F




                                                                                 G




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