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REPORT OF THE COMMITTEE

1. PROLOGUE

The present committee came to be constituted in terms of a communication

dated 6th May, 2016, under the signature of Shri Pravir Krishn Joint Secretary

(Ports] in the Ministry of Shipping, Government of India, (Annexure-1) with Dr.

Vedprakash Mishra Hon'ble Chancellor of Krishna Institute of Medical Sciences

(Deemed University], Karad and Chairman of the Academic Committee of the

Medical Council of India, New Delhi as Chairman of the Committee with Shri

Prakash Page, Chartered Accountant, Dr. Pradip Shingore, Dr. Prabhakar Kore,

Member of Parliament (Rajyasabha), Dr. Agrawal from Dr. Agrawals Eye Hospital,

Shri Ashutosh Pandya, Udaipur, Shri Samir Meghe, Member of Legislative

Assemble, Shri Ashish Deshmukh, Member of Legislative Assembly Maharashtra,

Dr. Ashok Khurana From Ultrasound Lab, New Delhi, Dr. Subhash Bhamre,

member of Parliament, Dhule, Maharashtra and presently Union Minister (State]

for Defense in Govt. of India, Shri P. D. Patil, President of D.Y. Patil Vidyapeeth,

Pune and Shri Sarang Kale as Members with Shri Abhishek Chandra Deputy

Secretary in the Ministry of Shipping as Member Secretary.

The terms of reference that were attributed to the present committee in terms

of the vested mandate was to study port hospitals at all the major ports and to

suggest model for development and the process to be followed for

modernization of the hospital on public private partnership basis at no cost to

the ports and also to explore the possibilities of setting up medical colleges

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along with these hospitals.

As such, the cardinal points that were taken up by the committee for the

purposes of making appropriate suggestions and recommendations are as

under:

1. The developmental propositions for the port hospitals have to be evoked

in terms of without any financial liability on to the said port hospitals.

2. Augmentation of the existing health care facilities and the services that

are being rendered by the existing port hospitals

3. Academic utilization of the hospital facilities at the Port Hospitals

including feasibility of starting of medical college and postgraduate

speciality courses.

4. The developmental plan to be proposed under the aegis of Public Private

Partnership Model

In order to crystallize the recommendations on the aforesaid counts set out by

the committee for itself commensurate with the terms of reference attributed to

it the committee took note of the existing policy frames that have been

stipulated by the Government of India, and the same are in vogue as of now as

in the context of these policy frames the suggestions would be evoked.

The committee taking into consideration the policy proposition of the Govt. of

India to the effect that in the districts where there is no Govt. Medical College, to

have a medical college on the Public Private Partnership Basis in all such

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districts whereby the District Hospitals would be upgraded and transformed into

teaching hospitals to be availed for starting of a Govt. run and sponsored

medical college without any accrual of heavy financial onus on the Govt. under

Public Private Partnership mode.

The committee took note of the fact that higher education including professional

education sector has grown tremendously. In terms of the observations brought

to fore by the Ministry of Health and Family Welfare, Government of India, the

number of Universities have increased by 34 times and colleges by a 74 times

ever since 1950. However, this quantitative expansion necessarily has not grown

with qualitative incorporations which is a matter of grave concern. The five year

plan period have taken note of the said gap and have ventured into various

initiatives and mechanisms to mitigate the same.

The 12th Five year plan recognizing the challenges confronting the domain of

higher education including medical education over a period of time proposed

initiative with reference to six focused areas wherein public private initiative

gains significance and relevance. The focused areas are :-

1. Expansion - Aiming at augmentation of the capacity in the existing institutions

2. Equity- To create targeted schemes for the backward and the minority communities

3. Excellence - building excellence through research and innovation, faculty development and internationalization.

4. Governance - Enhancing the institutional autonomy and transparency

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5. Funding-increasing public and private funding and linking them to the outcomes

6. Implementation and monitoring-towards improving coordination across the ministries and the agencies.

The medical education also hinges around these areas of focus contemplated

vide the various five years plan including the 12th Five year plan and starting of

medical colleges in desired number is one such significant initiative in the said

direction.2. STARTING OF A MEDICAL COLLEGE

It is pertinent to note that the procedure governing starting of a medical college

is stipulated under section 10(A) of the Indian Medical Council Act, 1956

(hereinafter referred to as 'Act'], which reads as under :

“1) Notwithstanding anything contained in this Act or any other law for

the time being in force-

a] No person shall establish a medical college, or

b] No medical college shall-

(i) Open a new or higher course of study or training (including a

postgraduate course of study or training], which would enable a

student of such course or training to qualify himself for the

award of any recognized medical qualification or

(ii] Increase its admission capacity in any course of study or training

(including a post-graduate course of study or training]

except with the previous permission of the Central Government

obtained in accordance with the provisions of this section.

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Explanation 1: For the purposes of this section, “person” includes

any University or a trust but does not include the Central Government.

Explanation 2: For the purposes of this section, “admission capacity”

in relation to any course of study or training (including post-graduate

course of study or training] in a medical college, means the maximum

number of students that may be fixed by the council (Medical Council

of India] from time to time for being admitted to such course or

training.

(2) (a] Every person or medical college shall, for the purpose of

obtaining permission under sub-section (1], submit to the Central

Govt. a scheme in accordance with the provisions of Cause (b) and the

Central Govt. shall refer the scheme to the Council for its

recommendations.

(b) The scheme referred to in clause (a) shall be in such form and

contain such particulars and be preferred in such manner and be

accompanied with such fee as may be prescribed.

(3) on receipt of the scheme by the council under sub-section (2), the

council may obtain such other particulars as may be considered

necessary by it from the person or the medical college concerned, and

thereafter it may-

(a) if the scheme is defective and does not contain any necessary

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particulars, give a reasonable opportunity to the person or college

concerned for making a written representation and it shall be open to

such person or medical college to rectify the defects, if any, specified

by the council.

(b) consider the scheme, having regard to the factors referred to in

subsection (7) and submit the scheme together with its

recommendations thereon to the Central Govt.

(4) The Central Govt. may after considering the scheme and the

recommendations of the council under sub-section (3) and after

obtaining where necessary such other particulars as other considered

necessary by it from the person or college concerned, and having

regard to the factors referred to in sub-section (7), either approve

(with such conditions], if any, as it may consider necessary] or

disapprove the scheme and any such approval shall be a permission

under sub-section (1).

Provided that no scheme shall be disapproved by the Central Govt.

except after giving the person or college concerned a reasonable

opportunity of being heard.

Provided further that nothing in this sub-section shall prevent any

person or medical college whose scheme has not been approved by

the Central Govt. to submit a fresh scheme and the provisions of this

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section shall apply to such scheme, as if such scheme has been

submitted for the first time under subsection (2).

(5) Where, within a period of one year from the date of submission of

the scheme to the Central Govt. under sub-section 2 no order passed

by the Central Govt. has been communicated to the person or college

submitting the scheme, such scheme shall be deemed to have been

approved by the Central Govt. in the form in which it had been

submitted, and accordingly, the permission of the Central Govt.

required under sub-section (1) shall also be deemed to have been

granted.

(6] In computing the time limit specified in sub-section (5] the time

taken by the person or the college concerned submitting the scheme,

in furnishing an particulars called for by the council, or by the Central

Govt. shall be excluded.

(7] The council, while making its recommendations under clause (b] of

subsection (3] and the Central Govt. while passing an order either

approving or disapproving the scheme under sub-section (4] shall have

due regards to the following factors -

a] Whether the proposed medical college or the existing medical

college seeking to open a new or higher course of study or

training, would be in a position to offer the minimum standards of

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medical education as prescribed by the Council under section

19(a] or, as the case may be, under section 20 in the case of

postgraduate medical education.

b] Whether the person seeking to establish a medical college or the

existing medical college seeking to open a new or higher course

of study or training or to increase its admission capacity has

adequate financial resources.

c] Whether necessary facilities in respect of staff, equipment,

accommodation, training and other facilities to ensure proper

functioning of the medical college or conducting the new course

of study or training or accommodating the increased admission

capacity have been provided or would be provided within the

time limit specified in the scheme.

d) Whether adequate hospital facilities having regard to the number

of students likely to attend such medical college or course of

study or training or as a result of the increased admission

capacity, have been provided or would be provided within the

time-limit specified in the scheme.

e) Whether any arrangement has been made or programme drawn

to impart proper training to students likely to attend such medical

college or course of study or training by persons having the

recognized medical qualifications.

f) The requirement of manpower in the field of practice of medicine

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and

g) Any other factors as may be prescribed

(8) Where the Central Govt. passes an order either approving or

disapproving under this section a copy of the order shall be

communicated to the person or college concerned.

The provisions of the Act on the said count are required to be read with the

regulations that are notified by the Medical Council of India as provided under

section 33 of the Act, which reads as under :

“33. Power to make regulations -

The council may, with the previous sanction of the Central Govt. make

regulations generally to carry out the purposes of this Act, and without

prejudice to the generality of this power, such regulations may provide for

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(a) the management of the property of the Council and the maintenance

and audit of its accounts;

(b)the summoning and holding of meetings of the Council, the times and

places where such meetings are to be held, the conduct of business

thereat and the number of members necessary to constitute a

quorum;

(c) the resignation of members of the Council;

(d) the powers and duties of the President and Vice-President

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(e) the mode of appointment of the Executive Committee and other

Committees, the summoning and holding of meetings and the conduct

of business of such Committees;

(f) the tenure office, and the powers and duties of the Registrar and other

officers and servants of the Council;

(fa] the form of the scheme, the particulars to be given in such scheme,

the manner in which the scheme is to be preferred and the fee payable

with the scheme under clause (b] of sub-section (2] of section 10A;

(fb) any other factors under clause (g) of sub-section (7] of section 10A;

(fc) the criteria for identifying a student who has been granted a medical

qualification referred to in the Explanation to sub-section (3) of section

10B;

(g) the particulars to be stated, and the proof of qualifications to be given

in applications for registration under this Act;

(h) the fees to be paid on applications and appeals under this Act;

(i) the appointment, powers, duties and procedure of medical inspectors

and visitors; (j) the courses and period of study and of practical training

to be undertaken, the subjects of examination and the standards of

proficiency therein to be obtained, in Universities or medical institutions

for grant of recognized medical qualifications;

(k) the standards of staff, equipment, accommodation, training and other

facilities for medical education;

(l) the conduct of professional examination; qualifications of examiners

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and the conditions of admissions to such examinations;

(m) the standards of professional conduct and etiquette and code of

ethics to be observed by medical practitioners; and

(m a) the modalities for conducting screening tests under sub-section

(4A), and under the proviso to sub-section (4B), and for issuing eligibility

certificate under sub-section (4B), of section 13,.

(n) any matter for which under this Act provision may be made by

regulations.

Accordingly, Regulations governing Establishment of Medical College as

contemplated under section 10(A) of the IMC Act, are in vogue as amended from

time to time (Annexure-2). The said regulation under section 2 titled Definition

the word appropriate 'Government' has been defined, which reads as under:

"Appropriate Government" means in respect of

establishment/instrumentalities/ agencies/undertaking under the

control of Central Government, the Central Government, and in

all other cases, the State/Union Territory Government"

The governing regulations provides for the scheme for obtaining permission of

the Central Govt. to establish a new medical college, wherein 'eligibility criterion'

have been stipulated as clause 1 and qualifying criteria at clause 2 respectively.

The 'Eligibility criteria' prescribed there under are -

(1) A State Government/Union territory;

(2) A University;

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(3) An autonomous body promoted by Central and State

Government by or under a Statute for the purpose of medical

education;

(4) A society registered under the Societies Registration Act,

1860 (21 of 1860) or corresponding Acts in States; or

(5) A public religious or charitable trust registered under the

Trust Act, 1882 (2 of 1882) or the WAKFS Act, 1954 (29 of 1954).

(6) *Companies registered under Company Act may also be

allowed to open medical colleges. Permission shall be withdrawn

if the colleges resort to commercialization.

The 'Qualifying Criteria' incorporated there under are -

The eligible persons shall qualify to apply for permission to establish a medical

college if the following conditions are fulfilled: -

(1] that medical education is one of the objectives of the applicant in case

the applicant is an autonomous body, registered society, charitable trust

& companies registered under Company Act.

(2] that a suitable single plot of land measuring not less than 25 acres is

owned and possessed by the person or is possessed by the applicant by

way of 99 years lease for the construction of the college (For the medical

colleges/Institutions established upto 30.11.2008}.

The medical college or medical institution shall be housed in a unitary campus of

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not less than 25 acres of land. However, this may be relaxed in a place

especially in Urban areas where the population is more than 25 lakhs, hilly

areas, and notified tribal areas where the land shall not be in more than two

pieces and the distance between the two pieces shall not be more than 10 kms.

The hospital, college building including library and hostels for the students,

interns, PGs/Residents and nurses shall be in one piece of land which shall not

be less than 10 acres. Other facilities may be housed in the other piece of land.

Proper landscaping should be done. (For the medical colleges/Institutions

established from 01.12.2008 to 12.11.2009}.

* As per the terms of Notification published on 13.11.2009 in the Gazette of

India. *The medical college or medical institution shall be housed in a

unitary campus of not less than 20 acres of land except in metropolitan

(New Delhi, Mumbai, Kolkata & Chennai] and A class cities (Ahmedabad,

Hyderabad, Pune, Bangalore and Kanpur}. However, this may be relaxed

in a place especially in Urban areas where the population is more than 25

lakhs, (*other than the nine cities mentioned in the Clause], hilly areas,

notified tribal areas, North Eastern States, Hill states and Union Territories

of Andaman & Nicobar Islands, Daman & Diu & Dadra & Nagar Haveli,

Lakshadweep, where the land shall not be in more than two pieces and

the distance between the two pieces shall not be more than 10 kms. The

hospital, college building including library and hostels for the students,

interns, PGs/Residents and nurses shall be in one piece of land which shall

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not be less than 10 acres. Other facilities may be housed in the other

piece of land. Proper landscaping should be done.

* As per the terms of Notification published on 30.01.2010 in the Gazette of

India.

However, in metropolitan cities (New Delhi, Mumbai, Kolkata & Chennai]

and “A” class cities (Ahmedabad, Hyderabad, Pune, Bangalore and

Kanpur], the permissible FAR/FSI would be the criterion for allowing the

medical colleges *provided that the built up area required for total

infrastructure o fa medical institute i.e., affiliated teaching hospital,

residential complex, with regard to amendment in Minimum Standard

requirement Regulations is made available in an area of not less than 10

acres based upon the permissible FAR/FSI allowed by the competent

authority (For the medical colleges/institutions established from

13.11.2009 onwards].

* As per the terms of Notifications published on 30.01.2010 in the Gazette of

India.

Clause 2 (2] shall be substituted as under:

*The medical college or medical institution shall be housed in a unitary

campus of not less than 20 acres of land except in mega cities (Mumbai,

Kolkata, New Delhi and Chennai] and 'A' class cities (Ahmedabad,

Hyderabad, Pune, Bangalore and Kanpur]. However, this may be relaxed

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lakhs, other than the nine cities mentioned in the clause, hilly areas,

notified tribal areas, North Eastern States, Hill States and Union Territories

of Andaman and Nicobar Islands, Daman and Diu, Dadra and Nagar Havel

and Lakshadweep, where the land shall not be in more than two pieces

and the distance between the two pieces shall not be more than 10 Kms.

The hospital, college building including library and hostels for the

students, interns, PGs/Residents and Nurses shall be in one piece of land

which shall not be less than 10 acres. Other facilities may be housed in

the other piece of land, proper landscaping should be done.

However, in mega cities (Mumbai, Kolkata, New Delhi and Chennai] and

'A' class cities (Ahmedabad, Hyderabad, Pune, Bangalore and Kanpur],

the permissible FAR/FSI would be the criterion for allowing the medical

colleges provided that the total build up area required for adequate

infrastructure including medical college, hospital, hostels, residential

quarters, and other infrastructure required as per Minimum Standard

Requirement Regulations is made available in an area of not less than 10


authority.”

* As per the terms of Notifications published on 26.02.2010 in the Gazette of

India.

The above has been amended as under:

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*The medical college or medical institution shall be housed in a unitary

campus of not less than 20 acres of land except in mega cities (Mumbai,

Kolkata, New Delhi and Chennai] and 'A' class cities (Ahmedabad,

Hyderabad, Pune, Bangalore and Kanpur]. However, this may be relaxed


lakhs, other than the nine cities mentioned in the clause, hilly areas,

notified tribal areas, North Eastern States, Hill States and Union Territories

of Andaman and Nicobar Islands, Daman and Diu, Dadra and Nagar Havel

and Lakshadweep, where the land shall not be in more than two pieces

and the distance between the two pieces shall not be more than 10 Kms.

The hospital, college building including library and hostels for the

students, interns, PGs/Residents and Nurses shall be in one piece of land

which shall not be less than 10 acres. Other facilities may be housed in

the other piece of land, proper landscaping should be done.

However, in mega cities (Mumbai, Kolkata, New Delhi and Chennai] and

'A' class cities (Ahmedabad, Hyderabad, Pune, Bangalore and Kanpur],

the permissible FAR/FSI would be the criterion for allowing the medical

colleges provided that the total build up area required for adequate

infrastructure including medical college, hospital, hostels, residential

quarters, and other infrastructure required as per Minimum Standard

Requirement Regulations is made available in an area of not less than 10


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authority.”

Further, in cases of Union Territory of Andaman and Nicobar Islands,

where existing Government Hospital is used as part of the Medical

college, the college, the library and the hostels for the students, interns,

PGs/Residents and nurses etc. can be housed on another plot of ten acres

within the radius of 5 kilometers.

* As per the terms of Notifications published on 14.10.2011 in the Gazette of India.

The above Clause 2(2] has been amended with the following addition

after third paragraph:

*Provided further for a period of five years in the states of Bihar,

Chhattisgarh, Jharkhand, Madhya Pradesh, Orissa, Rajasthan, Uttar

Pradesh and West Bengal, establishment of medical college shall be

allowed on two pieces of land comprising minimum of 20 (twenty) acres

of land. However, one plot of land shall not be less than 10(ten) acres and

the second plot of land shall also be not less than 5(five) acres. The

distance between two pieces of land shall not be more than 10(ten)

kilometers with well connected road and free transportation facility for

students and staff. The hospital should be on one piece of land and the

building of the college including library and hostels for the students,

interns, PGs/Residents, nurses may be housed on any of the two pieces of

land. The said hospital should be functional for atleast 3 years.

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The above relaxation shall not be available to a person seeking

permission to establish a medical college in a District in above states

where two or medical colleges are already in existence.

* in terms of Notification published on 04.06.2012 in the Gazette of India.

The above Clause 2(2) has been substituted for the first and second paragraph

with the following:

*Provided that in urban agglomerations/cities having population of 25

(twenty five) lakhs or more, namely, Delhi, Jaipur, Kanpur, Lucknow,

Kolkata, Ahmedabad, Surat, Greater Mumbai, Pune, Hyderabad,

Bangalore and Chennai, according to the Census of India, 2011 conducted

by Government of India, the permissible FAR/FSI shall be the criterion for

allowing the medical colleges provide that the total built up area required

for adequate infrastructure including medical college, hospital, hostels,

residential quarters, and other infrastructure required as per Minimum

Standard Requirement Regulations is made available in an area of not

less than 10 acres based upon the permissible FAR/FSI allowed by the

competent authority.

Provided further that in hilly areas, notified tribal areas, North Eastern

States and Union Territories of Andaman and Nicobar Islands, Daman and

Diu, Dadra and Nagar Haveli and Lakshadweep establishment of medical

college shall be allowed on two pieces of land comprising minimum of 20

(twenty] acres of land. However, one plot of land shall not be less than

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10(Ten] acres and the second plot of land shall not be less than 5 (five]

acres. The distance between two pieces of land shall not be more than 10

(ten] kilometers with well connected road and the medical college shall

provide free transportation facility for students and staff. The hospital

shall be on one piece of land and the building of the college including

library and hostels for the students, interns, PGs/Residents, nurses may

be housed on any of the two pieces of land.

*in terms of Notification published on 01.10.2012 in the Gazette of India.

In the above Clause 2(2] as amended on 01.06.2012, the following addition has been

made after the fourth paragraph:

*Provided further for a period of five years in States/Union Territories

other than Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Orissa,

Rajasthan, Uttar Pradesh and West Bengal, establishment of medical

college shall be allowed on two pieces of land comprising minimum of 20

(twenty) acres of land for utilization of District Hospitals by respective

State Government for opening of medical colleges. However, one plot of

land shall not be less than 10(Ten) acres and the second plot of land shall

also be not less than 5(five) acres. The distance between two pieces of

land shall not be more than 10 (ten) kilometers with well connected road

and free transportation facility for students and staff. The hospital should

be on one piece of land and the building of the college including library

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and hostels for the students, interns, PGs/Residents, nurses may be

housed on any of the two pieces of land. The said District Hospital should

be functional for atleast 3 years.

The above relaxation shall not be available to a person seeking

permission to establish a medical college in a District in the states where

two or more medical colleges are already in existence.


In the above Clause 2(2) the last paragraph, as given below, is deleted.

*The above relaxation shall not be available to a person seeking

permission to establish a medical college in a District in the states where

two or more medical colleges are already in existence.


(3) that Essentiality Certificate in Form 2 regarding No objection of the

State Government/Union Territory Administration for the establishment of

the proposed medical college at the proposed site and availability of

adequate clinical material as per the council regulations, have been

obtained by the person from the concerned State Government/ Union

Territory Administration.

(4) that Consent of affiliation in Form-3 for the proposed medical college

has been obtained by the applicant from a University.

(5) That the person owns and manages a hospital of not less than 300

beds with necessary infrastructural facilities capable of being developed

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into teaching institution in the campus of the proposed medical college.

The above Clause 2(5) has been substituted with the following:

*“That the person owns and manages a hospital of not less than 300 beds

with necessary infrastructural facilities capable of being developed into

teaching institution in the campus of the proposed medical college.

Provided that in North Eastern States and Hill States, the beds strength

required at the time of inception shall be 200 beds, which shall be

increased to 400 beds at the time of recognition for a medical college

having annual intake of 50 students and it shall be 250 beds at the time

of inception which shall be increased to 500 beds at the time of

recognition for a medical college having annual intake of 100 students.”

*in terms of Notification published on 22.10.2009 and 26.02.2010 in the Gazette

of India Addition has been made in the above Clause 2(5] after the last para with

the following:

*“Provided that any agency or instrumentality of appropriate Government

desirous of establishing a medical college may be permitted to utilize the

facilities of the hospital owned and managed by appropriate Government

entering into a Memorandum of Understanding for this purpose.”


The above Clause 2(5] shall substitute the last paragraph with the following:

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*Provided that an appropriate Government shall be permitted to allow the

utilization of the facilities of a hospital owned and managed by it for

establishing a Medical College by a person/agency by entering into a

Memorandum of Understanding for this purpose.”

Provided further that the clinical material, human resources and physical

infrastructure including beds are as per the relevant minimum standards

requirement, Regulations.*in terms of Notification published on 22.08.2014 in the Gazette of India

The following shall be added in Clause 2(5] after the last para, in terms of

Notification published on 29.05.2015 in the Gazette of India (Annexure-3)

“Further provided that the following conditions as set out below are

fulfilled and form part and parcel of the Memorandum of Understanding:

(1) That the hospital owned and managed by the appropriate

Government should be minimum 300 bedded hospital with necessary

infrastructural facilities capable of being developed into a teaching

institution situated on a plot of land having an area not less than

prescribed under the Regulations. The medical college shall provide free

transportation facilities for students and staff. The said hospital would be

on one piece of the land and the building of the college including library

and hostel for the students/interns, PGs/Residents, nurses may be housed

on any of the two pieces of land.

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(2) The minimum 300 bedded hospital has to be transferred by the

Government to the applicant trust/society/company through an

appropriate Memorandum of Understanding for a maximum period of 33

years or by way of lease upto 99 years. While transferring the

Government Hospital facility, the State Government may safeguard the

interest of State particularly in respect of admission of students under

Government Quota in the medical college and patient care in affiliated

Hospital(s) of the Medical College.

(3) The hospital must be suitably altered through appropriate

modifications into a teaching hospital specially with reference to the

break up of the 300 beds into 120 beds for Surgical Specialities, 120 for

Medical Specialities and 60 for Obst. & Gynae. and also capable of

forming clinical units of 30 beds each with required ward size, teaching

and training space and other prescribed requirements as per the

governing regulations before the application is made by the applicant for

starting the new medical college.

(4) The hospital should have all the feasibility for it being periodically

upgraded including the augmentation of the number of beds and

commensurate teaching units and teaching compliment as prescribed by

the Governing Regulations with respect to the permitted annual intake for

the college of 50/100/150/200/250 as the case may be.

(5) The personnel working in the said hospital, technicians, para clinical

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staff including nurses and the menial staff, if transferred to medical

college, upon their transfer shall be under the administrative control of

the Dean of the Medical College ensuring that there is no “duality” of

administrative control of any type.

(6) The administrative control so envisaged would include “Academic”,

“Clinical” and “Financial” aspects as well.

(7) The clinical staff working at the said hospital other than those who

conform to the prescribed eligibility for being designated as Assistant

Professor, Associate Professor, Professor of the concerned subject, as the

case may be prescribed by the Teachers' Eligibility Qualification

Regulations will have to be replaced by the full time appointment of the

requisite number of duly qualified full time medical teachers, such

replacement will not apply to nonteaching position like Casualty Medical

Officer, Hospital Administrators, etc. in accordance with the prescribed

requirements under the governing Regulations. In order to ensure that

the binding operational dictum that “teaching physician has to be the

treating physician” meaning thereby that the “treating” personnel would

be the one who would be the “teaching” personnel.”

*in terms of Notification published on 14.01.2016 in the Gazette of India (Annexure-4):

In Clause 2(5] under the heading “QUALIFYING CRITERIA”, point no. 2 of

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the last added para setting out the conditions to be fulfilled and to form

part and parcel of the Memorandum of understanding, the following shall

be substituted in terms of Notification published on 02.02.2016 in the

Gazette of India:-

(2] The minimum 300 bedded hospital has to be transferred by the


appropriate Memorandum of Understanding of minimum of 33 years or by

way of lease of 99 years preferably but in any case not less than 33

years. While transferring the Government Hospital facility, the State

Government may safeguard the interest of State particularly in respect of

admission of students under Government Quota in the medical college

and patient care in affiliated Hospital(s) of the Medical College.

As such, it is evident that Government of India, is eligible in terms of the

prescribed eligibility criteria for establish a medical college.

The qualifying criteria have been broadened by an amendment to the said regulation notified on 29th December, 2015 called as 'Establishment of Medical College Regulations' (Amendment 2015] whereunder, the Public Private Partnership modalities have been appropriately incorporated. A correction to the said amendment came to be notified by a Notification dated 02.02.2016 in the Gazette of India wherein the clause 2 the word 'maximum' has been replaced by the word 'minimum'. As a result the amended clause reads as under:

"The minimum 300 bedded hospital has to be transferred by the


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appropriate Memorandum of Understanding of minimum of 33

years or by way of lease of 99 years preferably but in any case

not less than 33 years. While transferring the Government

Hospital facility, the State Government may safeguard the

interest of State particularly in respect of admission of students

under Government Quota in the medical college and patient care

in affiliated Hospital(s) of the Medical College".

In the normal course the applicant for opening of a new medical college has to

own a and manage a minimum 300 bedded ongoing hospital as a condition

precedent, which by virtue of the amendment notified to the Governing

Regulation vide notification dated 29th December, 2015, whereby the conditions

that are required to be fulfilled and would be forming a part and parcel of the

Memorandum of Understanding to be evoked between a private party and the

concerned appropriate Govt. for the purposes of starting of a medical college.

In terms of the said provisions an appropriate Govt. may transfer a minimum

300 bedded hospital to the applicant trust/society/company through an

appropriate memorandum of understanding for a maximum period of 33 years

or by a way of lease up to 99 years. While transferring the Govt. hospital

facility, the State Govt. may safeguard the interest of the State

particularly in respect of admission of students under Government

Quota in the medical college and patient care in affiliated hospitals of

the medical college.

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The hospital so transferred has to be suitably altered through required

modifications into a teaching hospital specially with reference to a break up of

300 beds into 120 beds for surgical specialities, 120 for medical specialities, and

60 for Obst. And Gynecology and also has to have clinical units of 30 beds each

with required ward size, teaching and training space and other prescribed

requirements vide the Governing regulations before an application is preferred

by the applicant for starting of the new medical college.

It is also stipulated therein that the hospital so transferred ought to have all the

feasibility for its periodic upgradation including the augmentation of the number

of beds and commensurate teaching units and teaching compliment as

prescribed vide the governing regulations governing the annual permissible

intake of the concerned college for the MBBS course.

It is clearly prescribed therein that the personnel working in the said hospital,

technicians, para-clinical staff including the nurses and the menial staff is

transferred to medical college, upon their transfer shall be under the

administrative control of the Dean of the medical college, whereby there would

not be any duality of administrative control of any type. The administrative

control so envisaged includes 'academic, clinical and financial aspect' as well.

It is also made very clear therein that the clinical staff of such a hospital other

than those who conform to the prescribed eligibility for being designated as

'Assistant Professor, Associate Professor, Professor of the concerned subject' as

the case may be prescribed by the Teachers Eligibility Qualification Regulations,

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will have to be replaced by a full time appointment of the requisite number of

duly qualified full time medical teachers and such replacement will not be

applicable to the non-teaching positions including casualty medical officer,

hospital administrator etc. The core consideration guiding the same is that 'the

teaching personnel' has to be the 'treating personnel'.

In terms of this broadening incorporated in the governing regulation, the

applicant for starting of a medical college is not the appropriate Govt. but the

person, the trust, the society, the company to which the minimum 300 bedded

hospital is transferred is the applicant. However, the compensation that is

accruable to the concerned appropriate Govt. is that it would be entitled to

safeguard its interest in terms of provisions included at Clause 2 whereby, the

said Govt. would be able to do so in respect of admissions of students under the

Govt. quota in the said medical college and patient care in affiliated hospitals of

the medical college by mutual understanding, as may be evoked from time to

time. This model does not entail any financial liability on the appropriate Govt. of

any typa

It is pertinent to note that the General Body of the Medical Council of India at its

meeting held on 30th March, 2016 taking note of the limitation as in vogue in the

amended Regulation governing Establishment of Medical College (2015), and

intending to broaden the same have resolved as under (Annexure-5):

“The General Body, therefore, recommended that clause (2] of the

conditions of the Memorandum of Understanding should be amended

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to make it read as under:

"The appropriate Govt. (Central Govt./State Govt.) as the case

may be may permit an applicant Trust/Society/Company to

manage and run a hospital of not less than 300 beds and all its

facilities for a period of minimum 33 years through invocation of

an appropriate Memorandum of Understanding for

Undergraduate / Postgraduate /Super speciality medical

education"

This amendment ensures that the concerned hospital owned by the

appropriate Government is not transferred to a Trust / Society or a

Company. The recommendation so made by the General Body of the

Council would be forwarded to the Ministry of Health and Family

Welfare, Government of India, for approval and notification thereto.

In spite of the said amendment the present proposition makes

Public Private Partnership Model restrictive in as much as it is

limited to grant of permission by the appropriate Govt. to an

applicant Trust / Society / Company to utilize the facilities of the

minimum 300 bedded hospital for Under Graduate / Post

Graduate / Super Speciality Medical Education.

It may therefore, be broadened, so that a semi-Government

Undertaking may also be construed as eligible to make an

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application for starting of a medical college and be construed at

par with an applicant Trust / Society /

Company for the purposes of being permitted by the appropriate

Govt. to manage and run a hospital of not less than 300 beds and

all its facilities for a period of minimum 33 years for the purposes

of Under Graduate / Post Graduate/Super Speciality Medical

Education".

The said recommendations if approved, by the Government of India, would

result in an amendment to Clause 2, which would then stand substituted as

under:


may be may permit an applicant Trust/Society/Company to

manage and run a hospital of not less than 300 beds and all its

facilities for a period of minimum 33 years through invocation of

an appropriate Memorandum of Understanding for

Undergraduate / Postgraduate / Super speciality medical

education"

By virtue of the said incorporation the hospital owned by the appropriate Govt.

would not be required to be transferred as is the position vide the present

Regulation but would be required to permit an applicant Trust, Society or

company to manage and run the said hospital of not less than 300 beds and all

its facilities for a period of minimum 33 years through an appropriate invocation

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vide a Memorandum of Understanding for Undergraduate/Postgraduate/ Super

speciality medical education, as the case may be.

Further, the council has proposed to broaden the ambit of the said

Public Private Partnership model, so as to include a semi-Government

Undertaking to also be construed as eligible to make an application for

starting of a medical college and be construed at par with an applicant

Trust / Society / Company for the purposes of being permitted by the

appropriate Govt. to manage and run a hospital of not less than 300

beds and all its facilities for a period of minimum 33 years for the

purposes of Under Graduate / Post Graduate/Super Speciality Medical

Education".

In case the aforesaid recommendations unanimously made by the Medical

Council of India is approved by the Ministry of Health and Family Welfare,

Government of India, and is appropriately notified as an amendment to the

Governing Regulation a semi-Govt. undertaking would also be an eligible

applicant in terms of the eligibility criteria for starting of a medical college.

3. THE MODELS AS IN VOGUE

The models of medical colleges in the country as in vogue are in terms of the

eligibility criteria incorporated in the governing regulation. They are :

1. Medical colleges run and managed by the Central Govt.

2. Medical Colleges run and managed by the State Govt.

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3. Medical Colleges run by the Govt. of Union Territories

4. Medical Colleges run and managed by a University within the

scope and meaning of section 2(f) of the University Grants

Commission Act, 1956

5. Medical Colleges run and managed by the Deemed Universities

(Public Funded/Private Funded) within the scope and meaning of

Section 3 of the University Grants Commission Act, 1956.

6. Medical colleges run and managed by an autonomous body

promoted by Central and State Govt.

7. Medical colleges run and managed by an autonomous body under

a statute for the purposes of medical education.

8. Medical Colleges run and managed by a Society registered under

the Societies Registration Act, 1860 or a corresponding Acts in

the state as the case may be.

9. Medical colleges run by the statutory Municipal Corporations.

10. Medical colleges run and managed by a Public Religious or

Charitable Trust registered under the Trust Act, 1882 or the

WAKFS Act, 1954.

11. Medical colleges run and managed by the companies registered

under Companies Act with a rider that the permission for such

college would be withdrawn if the company resorts to

commercialization.

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4. PUBLIC PRIVATE PARTNERSHIP MODE

The concept of Public Private Partnership in a way defines a relationship

between the Public and the Private arena through an appropriate mode of

collaboration between the public authorities and the economic operators.

This mode of public private partnership in the developed world emerged in the

early 80s under the Reagan and Thatcher administrations for the purposes of

achieving goals in the domain of urban development. It was success in this

arena which realistically paved the way for its replication in other sectors, to the

extent that the momentum generated has resulted in the said modality being

construed as a solution to mitigate the ever growing expectations needs and

requirements for public services, which amongst other things also includes

quality based education in both the developing and the developed world.

United Nations Development Programme (UNDP] defines the Public Private

Partnership as several types of relationship between public and private sectors

for public service delivery. The private participants may include private

businesses as well as nongovernmental organizations and community based

organizations as well. The core assumption in the model is that it brings to fore

the merits of private sector which includes innovation, access to finance,

technological update, managerial efficacy and entrepreneurial spirit. These

advantages when merged with the inherent strengths of the public sector, the

hybridized results are vivid positive gains for the larger public good.

The Govt. of India, has observed that the public private partnership project,

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means a project based on the contract or concession agreement between a

Govt. or statutory entity on the one side and a private sector company on the

other side for delivering an infrastructure service on payment of user charges.

Taking into consideration the increasingly corporatized culture infiltrating in the

domain of medical education it is natural that the same has been included as a

'Service' or a 'Commodity' vide the General Agreement on Trade and Tariffs

(GATT] and World Trade Organization (WTO). It is on the said edifice that

strategic partnership in the public private partnership mode that have evolved

are private involvement in the curriculum development as well as evoking

quality centricity. The Dr. K. B. Pawar committee constituted by the University

Grants Commission has recommended the following four models of Public

Private Partnership in higher education -Model 1 :

Basic Infrastructure Model -

In this model, the private sector invests in infrastructure while the Govt. retains

the responsibility for the operations and the management of the institutions and

makes annualized payments to the private investors.

Model - 2

Outsourcing Model:

In this model, the private sector invests in the infrastructure and also has the

responsibility of the operations and the management of the institution, while the

Govt. pays the private investors for the specified services.

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Model-3

Equity or Hybrid Model:

This is a hybrid model wherein, the investments in infrastructure are shared

between the Govt. and the private sector, while the operations and the

management are with the private sector.

Model-4

Reserve Outsourcing Model:

This model proposes Govt. investments in the infrastructures and the private

sector with the responsibility towards the operations and the management.

5. PPP MODE IN MEDICAL EDUCATION

In the context of medical education, it needs to be noted that much before the

amendment to the qualifying criterion in the governing regulation in terms of the

Notification dated 28th October, 2013 published in the official Gazette of the

Government of India, where under it came to be provided that “an appropriate

Govt. shall be permitted to allow the utilization of the facilities of a hospital

owned and managed by it for establishing a medical college by a person /

agency by entering into a Memorandum of Understanding for this purpose

provided the clinical material, human resources and physical infrastructures

including beds are as per the Minimum Standards Requirements Regulations and

also its subsequent amendment in terms of notification dated 29th December,

2015 and subsequent correction vide a notification dated 2nd February, 2016, a

medical college came to be established under the Public Private Partnership

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Mode.

6. MANIPAL SIKKIM MEDICAL COLLEGE, GANGTOK, SIKKIM

The Ministry of Health and Family Welfare, Government of India, in terms of the

available records vide a letter dated 28th November, 1998 forwarded a proposal

received from the President, Manipal Foundation Manipal for establishment of a

new medical college at Gangtok, Sikkim by the Sikkim Manipal University of

Health, Medical and Technological Sciences, Gangtok, which came to be

constituted by a State Act.

The Government of India, had informed with regard to the ownership of the

hospital that the Sikkim State Government had transferred the 500 bedded

Govt. Central Referral Hospital to the University on 99 years lease. The Deed of

perpetual lease was made on 15th September, 1998 between the Governor of

Sikkim through the Secretary to the Govt. of Sikkim, Health & F.W. Deptt. and

Sikkim Manipal University of Health, Medical & Technological Sciences, Gangtok,

Sikkim established under the Sikkim

Manipal University of Health, Medical Technological Sciences Act, 1995

represented by its Vice Chancellor.

In the said Deed, it was categorically brought out that “the lessee shall

use the property and the building only for the purposes of office and

establishment of the university, hospitals, colleges, laboratories,

diagnostic centers, staff quarters, hostels, workshops and related

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facilities and other establishment connected with the activities of the

university including all facilities for multi speciality hospital with

advanced facilities and continuous up gradation thereof and nothing

else”.

In addition, it also provided that “the lessee shall provide super

speciality facilities such as super speciality diagnostic center including

ultrasound, echo cardiology, CT scan etc. and super speciality in-

patient department”.

Further, it was also stipulated therein that the lessee shall maintain all

the units/clinics/wards of the hospital at its running condition all the

time.

The Central Referral Hospital so leased in terms of its description was

an RCC framed structure of 09 stories with total plinth area of 33551.14

sq.mtrs.

The inspection team of the Medical Council of India that conducted inspection of

the said college on 15 /16/17 October, 1999 amongst other things had observed

in the report as under:-

“The college and the hospital are owned by the Govt. of Sikkim

whereas the day to day running equipping and the staff

procurement of the medical college is by Manipal Pai Foundation.

Thus, in Manipal Sikkim University, the Manipal component is the

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Manipal Pai Foundation whereas is the Sikkim component is the

Govt. of Sikkim. As such, there is a dichotomy about the

ownership and the manager ship whereas the mandatory

requirement under the Act is that it should be one the same.”

7. MEDICAL COLLEGE AT BHUJ, GUJARAT

After Bhuj, a geographical location in the State of Gujarat was heavily divested

due to earthquake as a part of rehabilitation the Govt. of Gujarat built a

independent hospital for rendering health services to the people thereat. By a

policy decision the said hospital came to be transferred to Adani Industrial

House, vide which a medical college has been created and is in vogue. This is

yet another case of a State Govt. transferring a hospital owned and managed by

it to a private person / trust for opening of a medical college and the application

to the required effect for the same under section 10(A) of the IMC Act, 1956, has

been granted and the said medical college is in vogue.

8. EMPLOYEES STATE INSURANCE CORPORATION MEDICAL COLLEGES

It may be noted that the Director General, Employees state Insurance

Corporation, New Delhi vide letter dated 30.8.2011 forwarded an application for

establishment of Employees State Insurance Corporation Medical College,

Bangalore by Employees State Insurance Corporation, New Delhi u/s 10A of the

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Indian Medical Council Act,1956. The hospital referred to in the said application

was the 350 bedded Employees State Insurance Corporation Hospital which is

owned and managed by the Employees State

Insurance Corporation under the Ministry of Labour & Employment, Government

of India.

The permission was accorded by the Central Govt. for the said college on the

recommendations of the Medical Council of India in terms of the procedure

stipulated under section 10(A] of the Act, read with governing regulations

thereto. As of now there are six medical colleges that are in vogue vide the said

pattern.

These three instances have been catalogued by the Committee for the

purposes of bringing to fore the utilization of non-teaching hospital for

the purposes of starting a medical college in one case between a

private partner in the form of State University and the other being the

State Government and in another case a Government run Corporation

availing its own service hospitals for starting of medical colleges.

However, these approaches per-se are not reflective of the public

private participation model in total operational sense.

9. AUTONOMOUS COUNCIL FOR GOVT. MEDICAL COLLEGES IN STATE OF MADHYA PRADESH

The Govt. of Madhya Pradesh in terms of a policy decision decided that all the

public funded Govt. Medical Colleges run and managed by the State of Madhya

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Pradesh would be put under an autonomous council to be headed by the

Minister of Medical Education in the Govt. of Madhya Pradesh. Each of the

colleges would be monitored by an Executive Committee under the overall

umbrella of the autonomous council to be headed by the Divisional

Commissioner of the Revenue Division , where under the concerned college is

located.

By virtue of placing the Govt. colleges under the autonomous council each of the

college was entitled to generate its own resources through its hospital facilities

for running and managing the affairs of the concerned medical college. To begin

with the staff, teaching and non-teaching which was working in the said medical

colleges continued to be paid salary out of the salary grants given by the State

of Madhya Pradesh, till such employees resigned took voluntary retirement,

superannuated or died. The autonomous council authorised the said medical

colleges to employ the eligible people against the vacancies on their own by

adhering to the reservation policy notified by the Govt. Under the autonomous

council the concerned colleges are supposed to bear the financial responsibility

of the salary as well of the incumbents appointed by it. The model has worked

successfully and is in vogue as of now.

However, it has to be borne in mind that the teaching/ non-teaching employees

appointed by the concerned college under the autonomous council are not open

to any transfers of any type. They continue to work in the concerned college.

The said model continues to be in vogue in the State of Chhattisgarh under the

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aegis of Govt. of Chhattisgarh a State which came to be carved out of the

erstwhile Madhya Pradesh.

10. MEDICAL COLLEGE RUN BY THE MUNICIPAL CORPORATIONS

The civic authorities of the cities as Municipal Corporations of the concerned city have also ventured into owning and managing the medical colleges out of their own resources. The classical examples are Mumbai Municipal Corporation in the State of Maharashtra and Surat Municipal Corporation, Ahmedabad Municipal Corporation in the State of Gujarat.

Nagpur Municipal Corporation was also running its Indira Gandhi Medical College

at Nagpur, however for financial difficulties the college was taken over by the

Govt. of Maharashtra and is now named as 'Indira Gandhi Govt. Medical College,

Nagpur'.

Further the medical colleges run by Surat Municipal Corporation and Ahmedabad

Municipal Corporation have now been put under the State Govt. Sponsored

Society.

11. MEDICAL COLLEGES UNDER STATE SPONSORED SOCIETY

The Govt. of Gujarat has evoked a model by placing certain medical colleges,

owned and managed by it under the society sponsored by the State Govt. of

which the Hon'ble Minister for Medical Education for the State is the Chairman.

Resultantly each of the college is now under the society with liberty to raise its

own financial resources for its cause. By virtue of the nature of the alteration of

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the said colleges, they have been immune from rendering their 15% seats to the

All India Quota the admissions to which are made by All India Pre-Medical Test

(AIPMT). The onus of salary of the staff is borne by the Govt. of those who were

primarily recruited by the State Govt. and later on came under the ambit of the

sponsored State. However, the teaching staff recruited by the society have their

pay-scales prescribed by it. However, as against the model of autonomous

colleges under the autonomous councils in the State of Madhya Pradesh,

whereby the staff recruited under the society is exclusively for the said college,

the Govt. of Gujarat still holds the authority of transferring the said staff within

the State as a part of governing and prescribed service conditions.12. MEDICAL COLLEGE BY GOVT. OF ANDAMAN AND NICOBAR

(UNION TERRITORY)

In terms of the permissibility incorporated in the governing regulation titled

'Establishment of a new Medical College' notified by the Govt. of India on the

recommendations of the Medical Council of India, the Govt. of the Union

Territory of Andaman and Nicobar availing the District Hospital owned by the

State Govt. thereat have started a Govt. run medical college in Andaman and

Nicobar in terms of scheme submitted by them under the provisions of Section

10(A) of the IMC Act, 1956.

The said model is a variant of the State Govt. owned models in as much as the

hospital that has been availed for starting of a medical college was a District

Hospital owned by the Govt. itself. As the governing regulation prescribes for the

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said permissibility and also certain relaxation for Union Territory Governments,

the same have been availed in the said model of starting and running of a

medical college by the Govt. of a Union Territory.

13. MAHATMA GANDHI INSTITUTE OF MEDICAL SCIENCES (SEVAGRAM), WARDHA MODEL

As a part of commemoration of Mahatma Gandhi centenary celebrations, the

Kasturba Health Society, which was founded by Mahatma Gandhi himself, a

medical college by name Mahatma Gandhi Institute of Medical Sciences, was

started in the year 1969 located at Sevagram, adjacent to Gandhiji's Ashram at

Wardha. The model pertaining to the said college is unique in terms of funding in

as much as that 50% of the expenditure on the said college is borne by the

Government of India, 25% by the Govt. of Maharashtra and remainder

25% by the parent Kasturba Health Society Trust. The college was

started in a rural set up to ensure that Gandhian Principles are

appropriately indoctrinated amongst the young generation for the

purposes of catering to the cause of health of the rural poor in the

country. The entrance test for admission to MBBS course at the said

college has a unique feature in as much as that the applicants have to

answer a question paper on Gandhian Thoughts and Principles and the

marks awarded thereat are computed with the performance of an

examinee at the remainder of the entrance examination for the

purposes of admission to the said Course. At the commencement of the

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academic year the students so admitted are required to undergo a

orientation camp of two weeks at Gandhi Ashram, Sevagram to get well

versed with the Gandhian Principles and way of life.

The core incorporation which is the crux of the issue is pertaining to

financing of the medical college. On this count it is necessary to note

that the financing for medical education can be made in the modes of -

1. Private-Private Mode

2. Private Public Mode

3. Public Private Mode &

4. Public-Public Mode

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A look at the financing of medical education would reveal that as of now three

modes of financing are in vogue.

1. Public funding

2. Private funding

3. Differential Fee Mode

The fourth mode that of Public Private Funding has been given a vent in

terms of the policy frame which has been notified by the Medical Council of

India, on 29th December, 2015. The operational mode permissible there under

is 'Public Private Mode'.

14. ENABLING CONDITIONS FOR A PARTNERSHIP

Any understanding has to have appropriate enabling conditions, so that the sameevolves in a desired manner and fructifies in the desired direction between the 'partners' for mutual benefits. The enabling conditions are :

1. A clear understanding of the responsibilities and obligations between the partners

2. Strong community support3. Need for some catalyst to start the process of partnership

(maybe an individual, a donor, a compelling vision or even a political or economic crisis)

4. Stability of the political (government) and legal climate (laws)5. Regulatory framework that is followed and enforced6. Capacity and expertise of the government at different levels in

designing and managing contracts (partnership)

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7. Appropriate organizational and management systems for partnerships

8. Strong management information system9. Clarity on incentives and penalties.

15. ISSUE OF EQUIVALENCE FOR RECOGNITION AS TEACHERS

In the context of the Public Private Partnership Mode governing opening of a

medical college brings to fore yet another aspect of recognition of persons

working in the nonteaching hospital to be recognized as 'teachers' in the context

of conversion of the said hospital from non-teaching to teaching hospital. Upon it

being availed for the purposes of opening of a medical college.

The first such occasion arose where under the non-teaching hospitals owned and

managed by the State Govt. by the Central Govt. where postgraduate courses

were permitted and were recognized the teachers teaching thereat were refused

recognition as postgraduate teachers by the examining and affiliating university

on the ground that they did not conform to the prescribed eligibility under the

teachers eligibility qualification regulation prescribed by the Medical Council of

India. In order to tackle the said issue on the recommendations to Medical

Council of India, the Govt. of India amended the Postgraduate Medical Education

Regulation vide a notification dated 15th March, 2005 by providing as under

(Annexure-6) :

"Consultants of specialists who have the experience of working for a period of not less than 18 years and 10 years in the teaching and other general departments in the institutions or

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hospitals, not attached to any medical college, where with the affiliation from any university, postgraduate teaching is being imparted as contemplated under sub regulation (1A) of regulation 8, shall respectively be eligible to be equated as Professor and Associate Professor in the Department concerned. The requisite experience for equating a consultant or specialist working in the super speciality departments of the said institutions or hospitals as Professor and Associate Professor shall respectively be 16 years and 8 years. Consultants or Specialists having postgraduate qualification, working in such an institution or hospital, who do not have the said period of experience, shall be eligible to be equated as Assistant Professor in the department concerned”

The core principle that has been availed in the said amendment is that the

number of years of professional experience for its equivalence with the teaching

experience are double the prescribed requirement of teaching experience. This

amendment was holding true for the purposes of recognition as postgraduate

teachers of those who were working in the said non-teaching hospitals and also

there equivalence with the corresponding cadre of Assistant Professor, Associate

Professor and Professor respectively at the level of speciality courses and also

that of super speciality courses.

After the permission came to be granted to medical colleges being owned and

managed by Employees State Insurance Corporation with their hospitals, the

issue came up as to how the staff working in these hospitals would be equated

for the purposes of teaching designation. The same came to be regulated

through issuance of an amendment to Minimum Qualifications for Teachers in

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Medical Institutions Regulation by a Notification dated 6 th August, 2012

published in the official Gazette of Govt. of India which provided as under

(Annexure-7):

1. For the post of Professor : "The requisite experience for equating a

Consultant or Specialist (after possessing postgraduate medical degree in the subject) working in the concerned speciality in a minimum 300 bedded ESI hospitals as professor shall be more than 18 years with four research publication in indexed journals as first author or corresponding author. Such consultant or specialist after joining a medical college shall be called as 'Designate Professor' and on completion of three years experience in the capacity of Designate Professor, such person shall be designated as "Professor".

2. For Associate Professor : "The requisite experience for equating a consultant or specialist after possessing postgraduate medical degree in the subject) working in the concerned speciality in a minimum 300 bedded ESI hospitals as professor shall be more than 10 years with two research publication in indexed journals as first author or corresponding author. Such consultant or specialist after joining a medical college shall be called as 'Associate Professor'.

3. For Assistant Professor : "The requisite experience for equating a consultant or specialist after possessing postgraduate medical degree in the subject) working in the concerned speciality in a minimum 300 bedded ESI hospitals as professor shall be more than 6 years. Such consultant or specialist after joining a medical

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college shall be called as 'Assistant Professor'.

It is pertinent to note that the said amendment as notified in the official Gazatte

as an amendment to Teachers Eligibility Qualification Regulation by the Govt. of

India on the recommendations of the Medical Council of India is limited to ESI

run and managed hospitals and hence the same cannot be made applicable to

any other similarly placed situation without an explicit amendment to the

required effect.

The Notification that has been issued on 29th December, 2015 on the Public

Private Partnership Model contemplates that the staff working in the non-

teaching hospital which is to be transferred by the concerned appropriate Govt.

to the private applicant for opening of a medical college in respect of its

recognition as teachers in the cadre of Professor, associate professor and

assistant Professor, would be subject to the fulfilment of the prescribed eligibility

in the Teachers Eligibility Qualification Regulation. This operationally means that

the modality of equivalence as is contemplated in the amendment of 2012 to

the Staff working in ESI hospitals for the purposes of opening of medical colleges

owned and managed by ESIS would not be applicable and available to the

colleges under the Public Private Partnership Model vide notification of 29 th

December, 2015.

Taking note of the same the Deputy Secretary in the Ministry of Health and

Family Welfare, Government of India, by a letter dated 28th January, 2016,

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addressed to the Secretary, Medical Council of India (Annexure-8) has brought

out that :

"The Ministry is implementing a central sponsored scheme (CSS) to establish new medical colleges attached with existing district/referral hospitals. 58 districts in 28 States/UTs have been identified under the scheme with focus on underserved areas. As may be seen, these are district headquarters much smaller in size than big cities where medical colleges are traditionally concentrated. The biggest constraint before the State Govt. / UTS is to find adequate faculties for these medical colleges. In this context, on the request of State Govt. it was considered in this Ministry that the specialists, after completion of PG degree working in these District hospitals may be designated as Professor, Associate Professor and Assistant Profess as per the formula of 18, 10 and 6 years experience in the concerned discipline along with requisite publications as was done in the case of ESI hospitals vide amendment notification dated 06.08.2012.MCI in its letter of 12.01.2016, has alluded to the amendment notification in Establishment of Medical College Regulations, 1999. However, the same will be applicable as terms and conditions of MOU for medical colleges that are proposed to be set up under PPP mode where the State Governments permit utilization of hospitals owned by it for establishment of new medical colleges by any private entity. Under the CSS, the medical colleges are proposed to be established as Govt. medical colleges by the State Governments/ Union Territories themselves. Further associate professor and professor are promotional posts and thus specialists doctors cannot be designated as such except

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when equivalence is clearly specified. It is therefore requested to reconsider the issue and furnish specific comments regarding the re-designation of PG qualified doctors in the State services as was done in the case of ESP hospitals vide amendment notification dated 06.08.2012."

As such a final policy decision on the said issue is pending as requisite

notification on the said count has not been issued by the competent authorities

that include Medical Council of India and the Central Govt. respectively.

16. CORE PENDING ISSUES

The two important issues that have a material bearing on the realistic and

meaningful operation of the Public Private Partnership model as has been

mooted vide the notification dated 29th December, 2015, which have been

brought out in this report itself are :

1. Recommendation made by the Medical Council of India upon its consideration

at its meeting of the General Body held on 30th March, 2016 to the Government

of

India, in respect of amending clause 2 of the Notification of 29th

December, 2015 to the effect that it should be rephrased as under:


may be may permit an applicant Trust/Society/Company to manage and

run a hospital of not less than 300 beds and all its facilities for a period

of minimum 33 years through invocation of an appropriate

Memorandum of Understanding for Undergraduate / Postgraduate

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/Super speciality medical education" is pending consideration with the

Government of India.

2. The issue raised by the Government of India, in their communication to

the Medical Council of India dated 28th January, 2016 in respect of

recognition / equivalence of specialists and consultants working in non-

teaching District / Referral Hospitals to be dealt in terms of the scheme

incorporated under the Notification governing ESI Hospitals issued by the

Government of India, on 6th August, 2012 for those applicants under the

Central Sponsored Scheme (CSS] vide the Public Private Partnership

Mode, is pending consideration as of now.

The clearance of these two pending issues are bound to facilitate the opening of

a medical college under a Public Private Partnership Mode as contemplated

under the Notification dated 29th December, 2015.

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17. FURTHER FACILITATION

Other than the two core issues that are pending consideration which if cleared

would go a long way in facilitating the operation of the proposed Public Private

Partnership Mode, yet another aspect which merits serious consideration is

broadening the scope and ambit of the word 'Public Private Partnership' itself so

as to ensure that it also need to mean as 'Private Public Partnership',

'Public-Public Partnership', and 'Private- Private Partnership' as well.

In this broadening what would be of interest to the State Govt. would be the

'Public- Public Partnership Mode' for a simple reason that in terms of the present

notification the feasibility is of opening a medical college by a private party

availing the transfer / permission of utilization of the facilities of a minimum 300

bedded hospital owned and managed by the State Govt. It is true that the

scheme provides that the interest of the State Govt. can be protected by virtue

of the provision made in Clause -2 to the effect that "the State Govt. may

safeguard the interest of the State particularly in respect of admission

of students under Govt. Quota in the medical college and patient care

in affiliated hospitals of the medical college". However, it is be but a

limited protection, because the nature of the college which is evolving vide the

said scheme ultimately is a privately run medical college and not owned and

managed by the State Govt.

In order to obviate this limitation it is necessary that the scope and ambit of the

Public Private Partnership model as has been brought out vide the Notification

issued by the Government of India, dated 29th December, 2015, on the

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recommendations of the

Medical Council of India is broadened, so as to provide for 'Public-Public

Partnership' Model as well, whereby the nature of the colleges, which could be

generated thereunder would be owned and managed by the State Govt.

whereby the limitation of protection of interest of the State to a limited extent

vide the Public Private Partnership mode can be done away with nay tided over.

18. OTHER REGULATORY APPLICABILITY

It is a matter of record that opening of a new medical college is governed vide

the regulatory scheme as is incorporated under section 10 A of the IMC Act,

1956 and other governing regulations notified thereto in relation to the same

vide section 33 of the said Act.

Be it regulations governing establishment of a medical college, minimum

standard requirements, teachers eligibility qualifications and modalities

governing recognition thereto, in terms of their amendments from time to time

are applicable to any and every opening of a medical college independent of

their nature be it private or public as the case may be. There is neither any

provision for a 'waiver' thereof or a 'condonation' thereto.

Taking into consideration the overall view of the situation and the various

contexts and factual propositions that have been delineated and accordingly

catalogued in the report, the committee is pleased to observe as under in the

context of the terms and reference that have been attributed to it for their

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appropriate dispensation.19. STARTING OF POST GRADUATE COURSES :

The policy frame pertaining to starting of post graduate courses that includes

MD/ MS (speciality Courses], Post Graduate Diploma Courses and Super

speciality courses (DM /M.Ch.] is governed by Regulations on Postgraduate

Medical Education 2000 Notified by the Government of India, on the

recommendations of the Medical Council of India and the Regulation governing

establishment of new medical college including postgraduate courses

respectively.

Apart from the eligibility pertaining to starting of a medical college or

postgraduate courses, section 8(1](A] of Regulations on Postgraduate Medical

Education clearly stipulates that 'a hospital which is owned and managed

by the State Govt. / Central Govt. is eligible for starting of a

postgraduate course including super speciality course without the

requirement of having a medical college of its own'. The permission would

be granted to the applicants under 8(1) (A) of the Regulations on Postgraduate

Medical Education by the concerned authorities subject to the fulfillment that

applicant either has a Memorandum of Understanding with a running medical

college in its geographical vicinity or it should have pre-clinical departments

namely that of Anatomy, Physiology and Biochemistry, Microbiology, Pathology,

Pharmacology and Forensic Medicine of the strength as is applicable under

Minimum Standard Requirement Regulation of the Medical Council of India for

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the purposes of starting a medical college with an annual intake of 50 seats.

Needless to state that the Minimum Standard Regulation for starting of a

medical college have stipulated specific and categorical requirements with

reference to a medical college with an annual intake of 50, 100, 150, 200, 250

as the case may be. As such, the proposed requirement that has been

prescribed pertains to the minimal annual intake capacity that is 50 seats per

annum.

20. APPROACH AT HAND:

The aforesaid policy considerations have been brought to fore for the purposes

of clarifying the policy ambit under which the utilization of Port Hospitals for

their academic utilization would be invoked.

The committee took the stock of the present status of the various Port Trust

Hospitals in terms of the information in the desired tabular format procured from

them in regard to the nature of healthcare services rendered, existing

infrastructural facilities, available working personnel and any academic

utilization, which is in vogue thereat along with the developmental plans that

are being harbored by them, if any.

The information so received was appropriately looked into and based on the

same the perspectives crystallized by the committee were as under:

a) Augmentation of all hospital facilities to Secondary and Tertiary

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levels of health care.

b) Linking identified hospitals for the purpose of opening of a new

medical college along with ancillary & para-medical courses

including nursing.

c) Evaluating the present status of the 12 hospitals in terms of

assets, services, instrumentation, infrastructure, personnel, cost

of services and clinical workload.

d) Requirement is to be tabulated in terms of minimum standard

requirements and regulations notified by the Medical Council of

India Act with reference to annual in-take of 100 & 150.

e) Feasibility study where this has to be done.

f) What exactly would be the approach including modes permissible

under the present policy and what would be the desired policy.

g) Present level of expenditure per month annually in terms of

medical facilities & HR incurred by each of the Port Hospitals.

In the context of the above, the hospital were grouped into distinct categories

based on their indoor bed strength namely -

a. Those hospitals that had more than 200 beds

b. Those hospitals that had bed strength from 100 to 200

c. Those hospitals that had bed strength less than 100

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Accordingly, based on the primary evaluation the committee proposed that

certain chosen hospitals would be visited for an onsite appraisal. Accordingly,

visits have been made to Port Hospitals at Mumbai, Cochin, Chennai, Kolkata

and Vishakhapattanam respectively.

The observations on the basis on onsite visit have been computed. Based on the

cumulative comparison and analytical assessment thereto the committee has

ventured into crystallizing its observations thereon.

The development plans which have been formulated by the respective Port Trust

Hospitals pertaining to their upgradation and augmentation of services rendered

have been made known to the Committee and the same would required to be

appropriately linked with the recommendations made by the committee.

The committee has also received the developmental plan for the Paradip Port

Trust Hospital by a consultant agency, which has been critically looked into by

the committee and it is a very meaningful and worthy plan in which needs to be

continued as it is as the same is comprehensively taking stock of even those

propositions which have been attributed to the present committee in the ambit

of its terms of reference for making the recommendations.

In the meantime the collateral happenings have also been taken note of by the

Committee, specially with respect to the Ministry of Health and Family Welfare,

Government of India, in consultation with Government of India, proposing that

the restrictive clause that was put in respect of a company being eligible to open

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a medical college that which is not for profit to be done away with, so that the

field becomes wide open. This was specially in the context of the fact that

although a company was included in the eligibility criterion in the governing

regulation in respect of opening of a new medical colleges, but as it was

restrictive that the applicant company should be a company not for profit, no

applicant came forward towards the same and the inference was easy to draw,

that the restriction was de-motivating.

The committee has also taken note of the another initiative by the Ministry of

Health and Family Welfare, in consultation with Medical Council of India that the

registered Trust / Societies / Waqf Boards that run an ongoing unaided private

medical college may also be given an opportunity by a suitable amendment to

the governing regulation that they would be also eligible to convert themselves

into a company for running the said medical colleges under them.

Needless to state that these two collateral happenings bear a significant impact

on the issue that the present committee is seized with. As such, how the said

propositions take shape is also a matter of concern of the committee from the

point of view of making necessary suggestions pertaining to the issue at hand

with the committee.

21. RECOMMENDATIONS1. The present mode of Public Private Partnership in terms of the

notification dated 29 th December, 2015, issued by the

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Government of India, on the recommendations of Medical

Council of India defines a single mode of the Public Private

Partnership, where-under an appropriate govt. can transfer its

minimum 300 bedded hospital to a private party for opening

of a medical college by the concerned private party as an

applicant within the scope and meaning of Section 10(A) of

the IMC Act, 1956. The interest of the Central Govt. in regard

to the extent of permissible admissions and utility of hospital

services from the attached hospitals thereat is limited. As

such, this mode does not go to fulfill the legitimate

requirement of the

Central Government to have its own medical colleges under

the proposed Public Private Mode.

2. The proposed Public Private Mode contemplates recognition to

the staff working in the non-teaching district/ referral hospital

as 'teachers' in the cadre of Professor, Associate Professor

and Assistant Professor strictly in conformity with the

eligibility prescribed under the governing Teacher Eligibility

Qualification Regulation, of Medical Council of India, which

would be non-conducive as staff at such hospitals conforming

to the said eligibility may be either miniscule in number or

non-existent. As such, the problem of requisite number of

teaching faculty with prescribed qualifications would be hard

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to procure and tough to find.

3. It would be appropriate to pursue the amendment to the

Notification of 29 th December, 2015, proposed by the Medical

Council of India at its meeting held on 30 th March, 2016,

modifying Clause 2, whereby under the Public Private

Partnership Mode the State Govt. instead of transferring its

district minimum 300 bedded district hospital under an MOU

would be required only to permit the utilization of facilities

thereat, which would be far more conducive to the legitimate

interest of the State Govt.

4. It would be equally appropriate to pursue the intent of the

Central Govt. as depicted in their communication dated 28 th

January, 2016, addressed to the Secretary, Medical Council of

India to extend the provision of scheme of equivalence and

recognition of teachers in case of Employee StateInsurance Corporation run hospital for opening of new medical colleges to the proposed medical colleges to be opened under the Central Sponsored Scheme (CSS).

5. It would be in the fitness of things to propose to the Central

Govt. that the applicability of the provision of scheme of

equivalence and recognition of teachers in case of Employees

State Insurance Corporation run hospitals for opening of new

medical colleges be made applicable as it is to the Public

Private Partnership Mode contemplated vide the Notification

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of 29 th December, 2015, by appropriately amending Clause 7

thereat so that the provision of conformity with eligibility

prescribed by the Teachers Eligibility Qualification Regulation

is done away with, so that the problem of appointment of

requisite number of faculty in conformity with the prescribed

standard regulatory requirements are dispensed of and are

found to be easy to tackle.

6. It may be pursued by the Central Govt. and the Medical

Council of India to broaden the ambit of the Notification of 29 th

December, 2015, so as to include Public-Public Partnership

Mode therein, whereby by a suitable collaboration with the

Public companies and undertakings which per se in their

individual capacity are not covered as eligible to be an

applicant for starting of a medical college, within the scope

and meaning of the eligibility criterion prescribed under the

governing Establishment of New Medical College Regulation

may be availed by the Central Govt. to open its own run

medical colleges.7. The Public-Public Partnership model will definitely give a

desired fillip to the Central Govt. to open new medical colleges commensurate with the need and requirement of the State with least financial burden as compared to any other model as in vogue for the said purpose.

8. In the fitness of things it would be appropriate to await the

outcome of the two core pending issues namely, a) the

broadening of the ambit of the notification of 29 th December,

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2015 and b) the broadening of the ambit of Teachers Eligibility

Qualification Regulation in terms of the applicability of

06.09.2012 Notification by the Government of India, before

embarking on the present available mode of Public Private

Partnership.

9. During the pendency of the same the Central Govt. may avail

the model of starting of a medical college as has been evoked

by the Govt. of Union Territory of Andaman and Nicobar where

under the concerned State Govt. availing his own District

Hospital has started a State run and managed medical college,

having full control on the admission of students thereto.

10. Further, the Ministry of Shipping, Government of India,

availing its owned more than 200 bedded Port Hospitals and

getting it converted into a teaching hospital may venture in

starting of a medical college owned and managed by the

Central Govt. itself thereby having complete and total control

of the same.

11. Alternatively, the Central Govt. following the public private

partnership model as contemplated in the notification of the

Medical Council of India dated 29.12.2015 and updated by

another notification dated 02.02.2016 transfer a more than

200 bedded Port Hospital at Mumbai to a Society/Trust or

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Company, as the case may be, for starting of a medical college

and protecting its interest by taking recourse to provisions

included at clause No.2 of the 29.12.2015 notification in

respect of admissions of students under the Govt. quota at the

said medical college and patient care in the affiliated hospital

of the concerned medical college on mutually agreed terms

and conditions ensuring that the services that are being

catered to the registered employees continue to be on the

same terms and conditions for all times without causing any

prejudice to their legitimate claim and entitlement.

12. In terms of the illustration availed by the Committee by an

appropriate extrapolation of financial receipts and

expenditures in regard to a medical college in the mode of

Public Private Partnership as recommended at seriatim 11, the

extent of admissions that can be availed by the Central Govt.

under its quota could be 25% of the total admissions annually

and 25% of the patient care in the affiliated hospital of the

said medical college vide transferring more than 200 bedded

Port Hospital to the concerned Society/Trust or the Company

(Annexure-9- bringing out an illustration with reference to

transfer of 300 District Hospital by the State Govt.), with

a rider that 15% of the annual intake should be earmarked s

the NRI (Non Resident Indian) quota towards which the higher

chargeable fee would be compensating for the fee charged

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against with 25% Central Govt. quota as a cross subsidy mode.13. The healthcare facilities at other port hospitals at Mumbai,

Cochin,

Chennai, Kolkata and Vishakhapattanam need to be upgraded

into tertiary care facilities vide invocation of Public Private

Partnership Mode under mutually agreeable terms and

conditions ensuring that the services that are being catered to

the registered employees continue to be on the same terms

and conditions for all times without causing any prejudice to

their legitimate claim and entitlement.

14. It would be appropriate that the upgradation to tertiary care

facilities could be worked up in a manner that a particular

super speciality stands assigned to a specific Port Trust

Hospital, which then becomes the super speciality centre for

all referral purposes by the remaining Port Hospitals. As such,

Port Trust Hospital Chennai could be availed for development

of tertiary care facilities in the domain of Cardiovascular

Thoracic surgery, Port Trust Hospital Cochin for Nephrology,

Port Trust Hospital Kolkata for Neurology and Neurosurgery

and Port Trust Hospital Vishakhapattanam for

Gastroenterology and Surgical Gastroenterology respectively.

15. The developmental plans as of now envisioned by the

respective Port Trust Hospitals in vogue to the extent

necessary be merged with the developmental suggestions

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made in respect to them by the present committee, so that

there is no overlap and the resources do not stand squandered

as they are scares and therefore precious hence are required

to be availed judiciously.16. The developmental plan in regard to Port Trust Hospital

Paradip, which the committee has looked into critically is well conceived and has incorporated the suggestions proposed by this committee in its ambit to a substantial extent and hence needs to be pursued as such.

17. A venture is necessary to start postgraduate courses at the

Port Hospitals other than Mumbai in the relevant specialities,

where the teaching beds are allocable to the concerned

speciality with available qualified teaching manpower in

identified specialities in terms of provisions included at

section 8(1)(A) of the Post Graduate Medical Education

Regulation, 2000 notified by the Medical Council of India by

making an appropriate MoU with the medical college in the

geographical vicinity to fulfill the condition which is prescribed

on the said count.

18. The venture of starting of post graduate courses could be

feasible at Port Hospitals Chennai, Cochin, Vishakhapattanam

and Kolkata.

19. In case of Port Hospital Mumbai if the feasibility of a medical

college does not work up then it should be availed for starting

of Post Graduate Courses in relevant specialities vide the

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qualified manpower available there including the requisite

number of teaching beds in terms of provisions included at

Section 8(1)(A) of the regulations governing Post Graduate

Medical Education notified by the Government of India, on the

recommendations of the Medical Council of India.20. At Port Hospitals other than Mumbai, Cochin, Chennai,

Vishakhapattanam,

Kolkata and Paradip the upgradation of the existing

healthcare facilities to sumptuous secondary and to some

extent tertiary care level need to be augmented for

enhancement of the quality of the services to be catered to

the relevant stakeholders.

21. All these initiatives as proposed would be under Public

Private Partnership Mode and therefore, could not end up in

any financial liability on the Central Govt. and the proposed

venture even for the starting of the Postgraduate courses

would be in tune with the one which has been worked out for

starting of a medical college in tandem with Port Trust

Hospital Mumbai, including the financial implications and

appropriate balancing of the resultant liabilities in an

illustrative manner.

The committee has ventured with purpose and sincerity to look into the entire

matter to its best possible capacity and bring to fore all that was thought to be

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relevant and appropriate, in terms of the terms of reference that were attributed

to it.

The committee feels that it is duty bound to record its gratitude to Hon'ble Shri

Nitin Gadkari, Union Minister for Surface Transport and Shipping, Government of

India, for placing his faith and trust towards dispensation of the task assigned to

it. The committee also records its appreciation and gratitude Shri Abhishek

Chandra, Member Secretary and all his associates for rendering required

secretarial assistance from time to time but for which the task accomplishment

would have been tough and difficult.Report submitted to the Hon'ble Union Minister for Surface Transport and Shipping,

Government of India for the needful as may be deemed appropriate.

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(Dr. Vedprakash Mishra)Honorary Chancellor,

Krishna Institute of Medical Sciences (DeemedUniversity), Karad

ChairmanFor and on behalf of the

Members of the Committee

(Abhishek Chandra)Deputy Secretary, Department of

Shipping, Govt. of India, New Delhi,

Member Secretary

Date : 4th July, 2017Place: New Delhi

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