High Court of KeralaSingle JudgeWrit petition disposed of; petitioners may appl...
Sreerag S.B. and Sreelakshmi S.B. and Mithun S. v. Kerala State Medical Council and National Medical Commission
Case / Petition Number:WP(C) No. 26617 of 2022
Case Details & Bench
- Court
- High Court of Kerala
- Hon'ble Judges
- V. G. Arun
- Judgment Date
- 2022-10-25
- Court Decision / Holding
- The writ petition is disposed of directing the first respondent to permit the petitioners to apply for permanent registration, and if applied, to grant permanent registration without insisting to undergo CRRI, if the applications are otherwise in order and satisfy the condition/criteria mentioned in Ext. P7 Circular.
- Final Disposition
- Writ petition disposed of; petitioners may apply for permanent registration and, if otherwise in order and meeting Ext. P7 criteria, permanent registration may be granted without CRRI.
Parties to the Case
Appellants / Petitioners
- Sreerag S.B.
- Sreelakshmi S.B.
- Mithun S.
Respondents
- Kerala State Medical Council represented by its Registrar
- National Medical Commission
Legal Representation & Advocates
Counsels for Petitioners
- • A. Rajasimhan
- • Vykhari K.U
- • Sharafudheen M.K.
Counsels for Respondents
- • N. Raghuraj
Case Synopsis & Summary
The petitioners—three Indian nationals who earned foreign medical degrees from Bangladesh and completed their internships abroad—challenged the Kerala State Medical Council’s insistence on compulsory Rotatory Residential Internship (CRRI) in India as a condition for permanent registration under Section 13 of the Indian Medical Council Act, 1956. They argued that advisories and regulations issued by the National Medical Commission (NMC) and related regulations permit foreign graduates who studied abroad and whose primary qualification is recognized for enrollment in the country of origin to be granted permanent registration without Indian CRRI, provided they meet prescribed criteria, including those in Exts. P4–P5. They relied on Exts. P2–P3 advisories showing acceptance of foreign training, the Sadhiya Siyad decision (KHC 2021) which held CRRI requirements could be inconsistent with IMC Act and regulations, and post-2021 NMC regulations, which include exemptions for pre-18.11.2021 qualifications. The respondents argued that Ext.R1(a) resolution mandating CRRI was adopted in public interest and previously upheld; they invoked Sundarjas Kanyalal Bhathija to urge referral to a larger bench. However, the court found that the National Medical Commission’s Foreign Medical Graduates Licentiate and Compulsory Rotating Medical Internship Regulations, 2021, along with Regulation 5 exempting pre-18.11.2021 graduates, render the CRRI requirement non-mandatory for petitioners who meet criteria (Ext. P7). The writ petition is disposed of by directing the first respondent to allow these petitioners to apply for permanent registration and, if otherwise in order, to grant permanent registration without CRRI.
Provisions of Law Cited
Section 13 of the Indian Medical Council Act, 1956Section 13(4A) of the Indian Medical Council Act, 1956National Medical Commission (Foreign Medical Graduates Licentiate) Regulations, 2021National Medical Commission (Compulsory Rotating Medical Internship) Regulations, 2021Regulation 3 of the Foreign Medical Graduates Licentiate Regulations, 2021Regulation 4 of the Compulsory Rotating Medical Internship Regulations, 2021Regulation 5 of the Licentiate Regulations, 2021Entry 66 of List I, Seventh Schedule of the Constitution
Legal Doctrines & Maxims
- Central legislation prevails over state enactments (IMC Act prevails over state enactments; supported by Entry 66, List I, Seventh Schedule)
- Directives issued by the National Medical Commission bind State Medical Councils
Submissions & Arguments
Contentions of Appellants / Petitioners
The petitioners urged that Exts. P2–P5 advisories and the regulatory framework post-2021 permit foreign medical graduates to be granted permanent registration without undergoing CRRI, even if the degree was obtained abroad, provided certain criteria are met and the qualification is recognized by the issuing country. They argued that pre-18.11.2021 qualifications are exempt from Regulation 4, and that Sadhiya Siyad v. State of Kerala supports their position that CRRI conditions are inconsistent with the IMC Act and related regulations. They relied on the 2017 Ext. R1(a) resolution, the subsequent Ext. R1(b) judgment, and the NM C’s 2021 Licentiate and Internship Regulations; they sought mandamus to process and grant permanent registration expeditiously without CRRI, subject to Ext. P7 criteria.
Contentions of Respondents
The respondents contended that Ext. R1(a) resolution mandating CRRI was enacted in public interest, and Ext. R1(b) upheld it; they argued that advisories/circulars by the NMC are persuasive rather than binding on State Councils. They submitted that the matter involves conflicting decisions (Sadhiya Siyad vs. older decisions) and cited Sundarjas Kanyalal Bhathija to argue refer to a larger bench. They maintained that Regulation 3, 4, 5 of the NM C 2021 regulations require appropriate conditions, and that the state council must follow the statutory framework and the centre’s advisories while the writ petition is pending appeal.
Cited Precedents (3)
| Case Name | Citation | Treatment | Explanation |
|---|---|---|---|
| Sadhiya Siyad v. State of Kerala | 2021 KHC 5832 | Positive | Supports that foreign medical graduates enrolled outside India can be granted permanent registration if conditions and central regulations permit, influencing the reasoning regarding CRRI exemptions. |
| Medical Council of India v State of Karnataka and others | (1998) 6 SCC 131 | Positive | Affirms that central IMC Act governs and prevails over state enactments, supporting central regulatory primacy in registration matters. |
| Sundarjas Kanyalal Bhathija and others v. The Collector, Thane, Maharashtra | (1989) 3 SCC 396 | Mentioned Only | Cited to argue that a larger bench may be warranted in case of conflicting opinions; not adopted as controlling authority in the present decision. |
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Extracted Judgment Text
Exact text extracted from official judgment records.
## **IN THE HIGH COURT OF KERALA AT ERNAKULAM**
## **PRESENT**
## **THE HONOURABLE MR.JUSTICE V.G.ARUN**
**TUESDAY, THE 25[TH] DAY OF OCTOBER 2022 / 3RD KARTHIKA, 1944**
## **WP(C) NO. 26617 OF 2022**
## **PETITIONER/S:**
1 SREERAG.S.B. AGED 24 YEARS S/O S.SATHEESH KUMAR, MADHAVAM, GR ROAD, OORUTTUKALA, NEYYATTINKARA.P.O., THIRUVANANTHAPURAM, PIN - 695121 2 SREELAKSHMI.S.B. AGED 24 YEARS D/O S.SATHEESH KUMAR, MADHAVAM, GR ROAD, OORUTTUKALA, NEYYATTINKARA.P.O., THIRUVANANTHAPURAM, PIN - 695121 3 MITHUN.S. AGED 26 YEARS S/O SAJI KUMAR.R., VAISHNAVAM, BHARANICKAVU.P.O., KATTANAM, ALAPPUZHA, PIN - 690503 BY ADVS. A.RAJASIMHAN VYKHARI.K.U SHARAFUDHEEN M.K.
## **RESPONDENT/S:**
1 KERALA STATE MEDICAL COUNCIL REPRESENTED BY ITS REGISTRAR, RED CROSS ROAD.P.O., THIRUVANANTHAPURAM, PIN - 695035 2 NATIONAL MEDICAL COMMISSION POCKET 14, SECTOR 8, DWARAKA.P.O., NEW DELHI, PIN - 110077 BY ADV N.RAGHURAJ
## **OTHER PRESENT:**
GP P.S.APPU
**THIS WRIT PETITION (CIVIL) HAVING BEEN FINALLY HEARD ON**
**26.09.2022, THE COURT ON 25.10.2022 DELIVERED THE FOLLOWING:**
WPC No.26617 of 2022
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## **JUDGMENT**
Dated this the 25[th] day of October, 2022
The petitioners are Indian nationals who have acquired Foreign Medical Degree from Bangladesh. After completing their degree course, petitioners did their internship in Bangladesh itself. Their grievance is regarding the first respondent/State Medical Council's insistence on the petitioners undergoing Compulsory Rotatory Residential Internship (CRRI) in India, as a condition for applying and granting permanent registration under Section 13 of the Indian Medical Council Act, 1956. The relief sought in this writ
petition are as under;
_“ Issue a writ of mandamus directing the 1[st] respondent to accept and process the application of the petitioners for permanent registration without insisting for Compulsory Rotatory Residential Internship (CRRI) and to grant permanent registration expeditiously in a time bound manner as fixed by this Hon'ble Court.”_
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2. Adv.A.Rajasimhan, learned Counsel for the petitioners submitted that, as per Ext.P1 notice, the Ministry of Health and Family Welfare, Government of India had declared the internship training completed by Indian nationals during his/her MBBS course in China to be acceptable for grant of permanent registration. Based on the decision, the Board of Governors appointed in supersession of the Medical Council of India had issued Ext.P2 advisory to the State Medical Councils, informing that MBBS or
equivalent primary medical qualification obtained
by an Indian national from countries like Bangladesh, Nepal, Philippines etc. shall also be taken into account while processing their
applications for permanent registration. Ext.P2 was followed up with Ext.P3 advisory, clarifying that the practical training undergone by an India Citizen, while acquiring primary medical qualification from a medical institution outside
WPC No.26617 of 2022
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India can be accepted, if such medical qualification is recognised for the purpose of enrollment in that country. Later, the National Medical Commission published the National Medical Commission (Foreign Medical Graduates Licentiate) Regulations, 2021 and the National Medical Commission (Compulsory Rotating Medical
Internship) Regulations, 2021 as per Exts.P4 and
P5 notifications dated 18.11.2021. Regulation 3 of Ext.P4 prohibits practice of medicine in India by a foreign medical graduate unless he is granted permanent registration in accordance with the provisions of the Licentiate Regulations. As per Regulation 4, a foreign medical graduate will not be granted registration unless he/she has undergone internship for a minimum duration of 12 months in the same foreign medical institution and supervised internship in India for a minimum term of 12 months, after applying for permanent registration. As per Rule 5,
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foreign medical graduates who have acquired foreign medical degree or primary qualification prior to the coming into force of the Licentiate Regulations are exempted from the rigor of Regulation 4.
3. As per Ext.P5 Regulations, internship in
India is made mandatory for foreign medical graduates. It is contended that as the
petitioners had acquired foreign medical degree prior to 18.11.2021, they are exempted from
undergoing compulsory rotating medical internship
in India. Reliance is placed on the decision in
in _**Sadhiya Siyad v. State of Kerala [2021 KHC**_
_**5832],**_ wherein a learned Single Judge declared the State Medical Council's insistence on the foreign medical graduates undergoing CRRI, as a condition for claiming permanent registration, to be inconsistent with the requirements of the Indian Medical Council Act and the Regulations.
WPC No.26617 of 2022
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Although the State Medical Council challenged that judgment in W.A.No.260 of 2022, the Division Bench did not stay the operation of the judgment and on the other hand, granted permission to the writ petitioner to apply for permanent registration and directed the State Medical Council to grant the registration subject to the result of the writ appeal. Reference is made to Ext.P7 Circular of the National Medical Commission stating that Exts.P4 and P5
Regulations are not applicable to foreign medical graduates who had acquired primary qualification before 18.11.2021. It is contended that in spite of the judgment in _**Sadhiya Siyad**_ and the advisories and clarifications issued by the National Medical Commission, the State Medical Council is still insisting on the petitioners completing CRRI in India before applying for permanent registration.
WPC No.26617 of 2022
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4. It is contended that this Court having set aside the resolution of the first respondent requiring foreign medical graduates to undergo compulsory internship in India, there is no legal basis for the continued insistence on foreign medical graduates undergoing CRRI in India. Finally it is submitted that, except the first respondent, all other State Medical Councils are acting in terms of the directives issued by the National Medical Commission and are granting permanent registration to foreign medical
graduates who have acquired their qualification prior to 18.11.2021. 5. Adv.N.Raghuraj, learned Standing Counsel
for the first respondent Council submitted that, as per Ext.R1(a) resolution dated 20.10.2017, the State Medical Council had decided to make it compulsory for foreign medical graduates to undergo internship in one of the MCI approved institutions before applying for permanent
WPC No.26617 of 2022
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registration. This decision was taken after considering all relevant aspects and in public interest. The decision was necessitated since the situation prevailing in Kerala is different from other States in India due to the large volume of ingress and egress of expatriates and migrant workers. The situation warrants knowledge and ability to diagnose all kinds of diseases likely to affect the community at large.
6. It is pointed out that Ext.R1(a) was
challenged before this Court and after elaborate consideration, a learned Single Judge rendered Ext.R2(b) judgment holding that the resolution, taken in public interest, cannot be interfered with. The court expressed the view that none of the provisions of the Act and the Regulations are
violated by the resolutions. Moreover, the intention is to protect the interest of the larger community by equipping foreign medical graduates to deal with state specific situations.
WPC No.26617 of 2022
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7. Although Ext.R1(b) judgment is
challenged in appeal, the Division Bench has not granted any interim order. It is contended that the advisories and circulars issued by the National Medical Commission has got only persuasive value and it is for the State Medical Council to decide and prescribe the eligibility criteria for registration. Relying on the Apex Court decision in _**Sundarjas Kanyalal Bhathija and others v. The Collector, Thane, Maharashtra**_
_**[(1989) 3 SCC 396]**_ , it is contended that in the light of Ext.R1(b) judgment rendered earlier, the learned Single Judge who rendered the judgment in _**Sadhiya Siyad**_ ought to have referred the matter to a larger Bench and should not have overlooked the earlier decision and rendered a different judgment.
8. It is true that in Ext.R1(b) judgment, the first respondent's decision to insist upon
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internship in India as a condition for grant of permanent registration was upheld. At the same time, it is to be noted that, the petitioners therein had not passed the qualifying examination, namely, the National Medical Licentiate Examination conducted in China. This crucial aspect had prompted the learned Single Judge to uphold Ext.R1(a) resolution. More pertinently, Exts.P4 and P5 Regulations had not been issued when Ext.R1(b) judgment was issued.
9. In _**Sadhiya Siyad**_ , after elaborate
consideration of Exts.P4 and P5, another learned Single Judge held that Indian nationals, who obtain medical qualification granted by medical institutions outside India, which is recognised for enrollment as Medical Practitioner in that country is entitled to be enrolled as a Medical Practitioner on any state medical register, on clearing the screening test in terms of Section 13(4A) of the IMC Act, provided such person has
WPC No.26617 of 2022
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already undergone one year internship in the country from which he obtained the qualification. It is also held that a person entitled for registration in a State Medical Register, in terms of the provisions of the IMC Act, cannot be denied registration by the State Medical Council. The said finding was rendered based on the decision in _**Medical Council of India v State of Karnataka and others [(1998) 6 SCC 131]**_ wherein
the Apex Court held that the IMC Act, which is relatable to Entry 66 of List 1 of the Seventh schedule of the Constitution would prevail over any state enactment relatable to Entry 25 or 26 of List III of the Seventh Schedule. Based on the findings, Ext.R1(a) decision of the first respondent was held to be invalid and unenforceable. The learned Single Judge observed that Ext.R1(b) judgment was one rendered without taking note of the above relevant aspects.
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10. Admittedly, Ext.R1(b) judgment and the judgment in _**Sadhiya Siyad**_ are pending in appeal and therefore, an authoritative pronouncement on the legality of Ext.R1(a) is to be decided by the Division Bench. As of now, this Court is faced with Ext.R1(b) judgment upholding Ext.R1(a) resolution and the decision in _**Sadhiya Siyad**_ declaring Ext.R1(a) to be invalid and unenforceable. Although learned Standing Counsel argued that when faced with two contradictory opinions by courts of co-ordinate strength, propriety demands that the matter should be referred to a Bench of larger strength, in the instant case, such procedure need not be adopted since the National Medical Commission (Foreign Medical Graduates Licentiate) Regulations, 2021 and the National Medical Commission (Compulsory Rotating Medical Internship) Regulations, 2021 notified after Ext.R1(b) judgment was rendered.
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The above notifications with the exemption provided in Regulation 5 of the Licentiate Regulations leaves no room for doubt that foreign medical graduate who have acquired their qualification before 18.11.2021 are entitled for permanent registration if they have done their internship from the same country and the qualification they have acquired is recognised by that country. As regards the contention that the
directives of the National Medical Commission need not mandatorily be followed by the State Medical Council, I am in respectful agreement
with the finding in _**Sadhiya Siyad**_ that Entry 66
of List 1 of the Seventh schedule of the
Constitution would prevail over any state
enactment relatable to Entry 25 or 26 of List III
of the Seventh Schedule. Being so, the State Medical Council is bound to act in terms of the
directives issued by the National Medical
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Commission.
In the result, the writ petition is disposed of directing the first respondent to permit the petitioners to apply for permanent registration, and if applied, to grant permanent registration without insisting to undergo CRRI, if the applications are otherwise in order and the petitioners satisfy the condition/criteria mentioned in Ext.P7 Circular.
Sd/-
**V.G.ARUN JUDGE**
Scl/
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## **APPENDIX OF WP(C) 26617/2022**
|PETITIONER|EXHIBITS|
|---|---|
|ExhibitP1|TRUE COPY OF THE UNDATED NOTICE|
||PUBLISHED IN ITS WEBSITE MINISTRY OF|
||HEALTH AND FAMILY WELFARE, GOVT. OF|
||INDIA|
|ExhibitP2|TRUE COPY OF THE LETTER NO. MCI-203(1)|
||(GEN.)/2020-REGN./112442 DATED 30-7-|
||2020|
|ExhibitP3|TRUE COPY OF THE LETTER NO. MCI-203(1)|
||(GEN.)/2020-REGN./118239 DATED 2-9-|
||2020|
|ExhibitP4|TRUE COPY OF THE NATIONAL MEDICAL|
||COMMISSION (FOREIGN MEDICAL GRADUATES|
||LICENTIATE) REGULATIONS, 2021|
|ExhibitP5|TRUE COPY OF THE NATIONAL MEDICAL|
||COMMISSION (COMPULSORY ROTATING|
||MEDICAL INTERNSHIP) REGULATIONS, 2021|
|ExhibitP6|TRUE COPY OF THE INTERIM ORDER IN WA|
||NO. 260/2022 DATED 23-2-2022|
|ExhibitP7|TRUE COPY OF THE CIRCULAR NO.|
||U.15024/4/2022-UGMEB/ DATED 4-3-2022|
||ISSUED BY THE 2ND RESPONDENT|
|ExhibitP8|TRUE COPY OF THE ELIGIBILITY|
||CERTIFICATES DATED 1-7-2020 ISSUED BY|
||THE MEDIAL COUNCIL OF INDIA TO THE 1ST|
||PETITIONER|
|ExhibitP9|TRUE COPY OF THE ELIGIBILITY|
||CERTIFICATES DATED 1-7-2020 ISSUED BY|
||THE MEDIAL COUNCIL OF INDIA TO THE 2ND|
||PETITIONER|
|ExhibitP10|TRUE COPY OF THE ELIGIBILITY|
||CERTIFICATE DATED 10-11-2020 ISSUED BY|
||THE MEDIAL COUNCIL OF INDIA TO THE 3RD|
||PETITIONER|
|ExhibitP11|TRUE COPY OF THE MBBS DEGREE|
||CERTIFICATES DATED 9-6-2021 ISSUED BY|
||THE UNIVERSITY OF RAJSHAHI, BANGLADESH|
||TO THE 1ST PETITIONER|
|ExhibitP12|TRUE COPY OF THE MBBS DEGREE|
||CERTIFICATES DATED 9-6-2021 ISSUED BY|
WPC No.26617 of 2022
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||THE UNIVERSITY OF RAJSHAHI, BANGLADESH|
|---|---|
||TO THE 2ND PETITIONER|
|ExhibitP13|TRUE COPY OF THE MBBS DEGREE|
||CERTIFICATES DATED 9-6-2021 ISSUED BY|
||THE UNIVERSITY OF RAJSHAHI, BANGLADESH|
||TO THE 3RD PETITIONER|
|ExhibitP14|SCREENING TEST PASS CERTIFICATE DATED|
||9-2-2022 ISSUED TO THE 1ST PETITIONER|
|ExhibitP15|SCREENING TEST PASS CERTIFICATE DATED|
||9-2-2022 ISSUED TO THE 2ND PETITIONER|
|ExhibitP16|TRUE COPY OF THE SCREENING TEST PASS|
||CERTIFICATE DATED 30-7-2022 ISSUED TO|
||THE 3RD PETITIONER|
|ExhibitP17|TRUE COPY OF THE CERTIFICATE OF ONE|
||YEAR INTERNSHIP TRAINING COMPLETION|
||DATED 11-6-2022 OF 1ST PETITIONER|
|ExhibitP18|TRUE COPY OF THE CERTIFICATE OF ONE|
||YEAR INTERNSHIP TRAINING COMPLETION|
||DATED 19-6-2022 OF 2ND PETITIONER|
|ExhibitP19|TRUE COPY OF THE CERTIFICATE OF ONE|
||YEAR INTERNSHIP TRAINING COMPLETION|
||DATED 21-6-2022 OF 3RD PETITIONER|
|ExhibitP20|TRUE COPY OF THE STUDENT COPY-|
||INTERNSHIP COMPLETION CERTIFICATE|
||DATED 30-6-2022 OF THE 1ST PETITIONER|
|ExhibitP21|TRUE COPY OF THE STUDENT COPY-|
||INTERNSHIP COMPLETION CERTIFICATE|
||DATED 20-6-2022 OF THE 2ND PETITIONER|
|ExhibitP22|TRUE COPY OF THE STUDENT COPY-|
||INTERNSHIP COMPLETION CERTIFICATE|
||DATED 30-6-2022 OF THE 3RD PETITIONER|
|ExhibitP23|TRUE COPY OF THE CERTIFICATE OF FULL|
||REGISTRATION AS A MEDICAL PRACTITIONER|
||DATED 30-6-2022 ISSUED TO THE 1ST|
||PETITIONER|
|ExhibitP24|TRUE COPY OF THE CERTIFICATE OF FULL|
||REGISTRATION AS A MEDICAL PRACTITIONER|
||DATED 3-7-2022 ISSUED TO THE 1ST|
||PETITIONER|
|ExhibitP25|TRUE COPY OF THE CERTIFICATE OF FULL|
||REGISTRATION AS A MEDICAL PRACTITIONER|
||DATED 3-7-2022 ISSUED TO THE 2ND|
WPC No.26617 of 2022
-17-
||PETITIONER|
|---|---|
|ExhibitP26|TRUE COPY OF THE CERTIFICATE DATED 5-|
||7-2022 ISSUED BY HIGH COMMISSION OF|
||INDIA TO THE1ST PETITIONER|
|ExhibitP27|TRUE COPY OF THE CERTIFICATE DATED 5-|
||7-2022 ISSUED BY HIGH COMMISSION OF|
||INDIA TO THE 2ND PETITIONER|
|ExhibitP28|TRUE COPY OF THE CERTIFICATE DATED 5-|
||7-2022 ISSUED BY HIGH COMMISSION OF|
||INDIA TO THE 3RD PETITIONER|
|ExhibitP29|TRUE COPY OF THE INCOMPLETE|
||APPLICATION SUBMITTED BY THE 3RD|
||PETITIONER IN THE WEBSITE OF THE 1ST|
||RESPONDENT|
|ExhibitP30|TRUE COPY OF THE APPLICATION FILLED BY|
||THE 1ST PETITIONER IN THE OFFICIAL|
||WEBSITE OF THE TAMILNADU MEDICAL|
||COUNCIL|
|RESPONDENT EXHIBITS||
|Exhibit R1(a)|TRUE PHOTOCOPY OF THE RESOLUTION DATED|
||20.10.2017.|
|Exhibit R1(b)|TRUE COPY OF THE JUDGMENT DATED|
||21.08.2019 IN W.P.(C) NO.39576 OF|
||2018.|
|Exhibit R1(c)|TRUE PHOTOCOPY OF THE MINUTES OF THE|
||MEETING OF THE UGMEB HELD ON|
||19.05.2021.|