Rules affecting the medical infrastructure of the state

Tamil Nadu has been in the midst of a journey for some time now to set up a medical college in every district. It aims to ensure efficient delivery of advanced medical care to residents. For this there is a need for specialist and super-specialist doctors to staff the various departments in the medical colleges and hospitals of the state.

policies by state

To ensure full value of its investments and maintain institutional continuity, the state brought in three policies. A quota was created in which 50% seats in government medical colleges were earmarked for doctors working in government institutions (in-service candidates) with the condition that they need to work in Tamil Nadu medical services till retirement. To absorb trained super-specialists who are not attached to Tamil Nadu Medical Services (Non-Service candidates), for them to serve for at least two years in Government Hospitals (after the completion of their training) made a bond; It also created a domicile requirement for them to appear in the super-specialty entrance exam.

editorial | Tamil Nadu case against NEET

Till 2015-16, admission to Tamil Nadu super-specialty medical seats was on the basis of state entrance examination, with domicile requirement and in-service quota. The domicile requirement for admission to super-specialty courses required by the states of Tamil Nadu, Andhra Pradesh and Telangana was upheld in 2016 by a Supreme Court bench comprising Justices Dipak Misra and Prafulla C. Pant was terminated after a decision. He indirectly invoked the decision of the nine-judge bench Indira Sawhney Adi Vs Union of India (1992) which requires super-specialty seats in medicine to be out of the purview of reservation, with no plausible reasons for domicile or reservation or ‘efficiency of administration’.

With the introduction of the National Eligibility cum Entrance Test-Super Specialty (NEET-SS) conducted by the National Board of Examinations from 2017-18, state governments robbed their ability to conduct entrance exams and conduct counseling for super-specialty seats . Their medical colleges were required to surrender 100% of their seats to the all-India quota to the states. As an extension, the in-service quota was null and void.

In-service quota, instructions

a writ petition (Writ Petition (Civil) No. 196 of 2018) was filed by the Tamil Nadu Medical Officers Association (TNMOA) for removal of 50% in-service quota for post-graduate medical courses on behalf of in-service doctors in Tamil Nadu. The Constitution Bench, while disposing of the matter on in-service quota with an order on August 31, 2020, said that except for the determination of minimum standards and coordination, TeaThe power of the state in regulating medical education is preserved. He said the state authorities can provide quota for in-service doctors from within the state’s own merit list, with the aspiring doctors having to clear the NEET exam with minimum prescribed marks.

Tamil Nadu GO

Expanding the directions of the Constitution Bench, the Department of Health and Family Welfare, Government of Tamil Nadu issued GO (Ms) No. 462 on November 7, 2020. Through this GO, the Tamil Nadu government sought to implement. 50% quota in super-specialty seats in the state for in-service candidates. As the admission process was in the final stages, the Supreme Court Bench on November 27, 2020 decided not to allow quota for in-service doctors for the year 2020-21 alone.

with skepticism around the line of judgment TNMOA vs Union of India and the validity of GO (Ms) No. 462 by the Government of Tamil Nadu, it remains to be seen what trajectory the Supreme Court’s decisions take.

Administration and Inclusion

Maintaining the efficiency of administration is an argument that is consistently invoked by the Supreme Court to deny the demands for reservation/quota through Article 335 of the Constitution. It is here that the working definitions of “efficiency”, “competence” and “efficiency of administration” in government are prompted to question which courts follow. A welcome move in this regard is the judgment of a two-judge bench of the Supreme Court (Justices Uday Umesh Lalit and DY Chandrachud). BK Pavitra Vs Union of India (2019) which leads the courts to define the multidimensional term “efficiency of administration” which is based on inclusion.

This definition should have a system-view of the broader impact that removal of the domicile requirement and quota in service can have on the integrity of the state medical infrastructure. On August 25, 2021, the Director of Medical Education issued a letter to the Deans of Medical Colleges requesting them to receive an undertaking from non-service super-specialty doctors of 2020-21 who have not opted or are not willing to take are posting even when vacancies are available in their particular departments. It is understood that about 80% of the other state super-specialty candidates, who are more than 50% in government medical colleges in Tamil Nadu, did not attend the counseling conducted for the posting. In Tamil Nadu, with domicile and in-service quotas, the percentage of in-service candidates in super-specialty seats was around 40%. But with the removal of domicile and in-service quota, in the post-NEET-SS scenario, the percentage of in-service candidates has come down to 6%.

This is where Advocate Wilson raised this issue. Dr. Prett Sharma vs. Dr. Billu B.S. (2020), implementing the Supreme Court’s decision allowing quota in service in super-specialty medical courses as seen in Of. Duraisamy and others. TN vs State (2001) 2 SCC 538 and Modern Dental College and Research Center and others. Vs State of Madhya Pradesh and others. (2016) 7 SCC353, holds more significance.

Linked to the delivery of public health with the sustenance of medical infrastructure, for which states are responsible through the constitution, one has to wonder if the higher judiciary consistently intervenes by the state to maximize outcomes through domiciles, quotas Why rule against For serving candidates and bond requirements.

Dr. Yazini PM is a General Physician based in Chennai. Jayanathan Karunanidhi is an independent policy analyst and a water professional, also based in Chennai. Views expressed are personal