Specialist Doctors Refusing To Work In Govt Hospitals Are Infringing Fundamental Rights Of Poor And Needy Patients: Madras HC

It is definitely most reassuring to note now that none other than the Madras High Court in a most learned judgment titled S. Sahana Priyankaa Vs The State of Tamil Nadu & Ors in W.P. Nos.10799, 10826 and 10829 of 2024 (3 cases) and W.M.P.Nos.11900, 11901, 11903, 11936, 11937, 11939 11941, 11942 & 11943 of 2024 and cited also in Neutral Citation No.: 2024:MHC:1907 that was pronounced on 22.04.2024 while taking a very grim view of the specialist doctors refusing to work in government hospitals has been most forthright in holding that the doctors after undergoing medical specialty courses, refusing to work in Government Hospitals, infringe upon the fundamental rights of the poor and needy patients. It must be noted that the Single Judge Bench comprising of Hon’ble Mr Justice SM Subramaniam underscored and upheld the obligation for medical graduates to fulfill bonded service in government medical institutions. We need to also note that the Bench had no reluctance to point out that the general public had the right to expect such specialists to utilize their services during their training for the benefit of the sick, poor and needy. Therefore, it was but natural for the government to ensure that such doctors who have undergone post-graduate training at a very low cost by utilizing resources from the poor and needy serve the poor and needy not only for the country but also for the State of Tamil Nadu in particular.

At the very outset, this notable judgment authored by the Single Judge Bench comprising of Hon’ble Mr Justice SM Subramaniam sets the ball in motion by first and foremost putting forth in para 1 that, "The proceedings of the Director of Public Health and Preventive Medicine appointing the petitioners as Assistant Surgeon (Specialists) based on the bond agreement under Rule 19(1) of the Tamil Government Servants (Conditions of Services) Act, 2016 are under challenge in the present writ petitions."

To put things in perspective, the Bench envisages in para 2 that, "The petitioners were appointed temporarily to the post of Assistant Surgeon in compliance with the bond agreement executed by the petitioners. It is not in dispute that the petitioners secured admission for Post Graduate Medical Course by executing a bond stating that on completion of the course, the petitioners will serve in the Government Medical College and Hospital for a period of two years. Such a bond has been executed considering the fact that the Government is spending considerable amount for these Post Graduate Medical students to undergo the Medical course. In order to provide specialized medical services to the poor and the needy people across the State of Tamil Nadu, a condition was imposed to serve minimum period of two years in Government Medical College and Hospitals after completion of course. Admittedly, the bond conditions stipulated are agreed by the petitioners."

As it turned out, the Bench then enunciates in para 3 that, "After completing the course, the petitioners claim that they had served during Covid-19 pandemic period and the said period is also to be reckoned for the purpose of calculating two years of service as per the conditions stipulated in the bond."

Do note, the Bench notes in para 6 that, "Considering the claim of many such students, the Government itself has reduced the period from two years to one year in G.O.(Ms)No.351 dated 27.10.2023. Therefore, the petitioners have to complete one year of service in any Government Medical College and Hospital in compliance with the bond conditions."

Be it noted, the Bench then notes in para 9 that, "It is natural that the Government desires to ensure that these Doctors, who have underdone Post Graduate training at a very low cost by utilizing the poor people, to serve the poor and the needy of our great nation at large and the State of Tamil Nadu in particular. The public have the right to expect the Specialists to utilize their service during their training for the benefit of the sick, poor and the needy. To ensure that the services of trained Post Graduate Doctors are made available to the poor and the needy patients, a bond signed by the candidates with three sureties is obtained from the candidates at the time of their admission. The candidates are a well qualified registered medical practitioner with adequate knowledge and only after carefully reading the bond and understanding it and after being fully aware of the terms and conditions of the bond have signed and they have not been forced to sign the bond."

It is worth noting that the Bench notes in para 10 that, "It is believed that such an attitude of the doctors if allowed, will encourage the attitude of not paying attention to those poor people at whose expense they have been educated, which is opposed to public interest and unacceptable. In spite of executing the bond, many of the candidates after completing their course, neither worked in Government Institutions nor paid the bond amount but in some cases, after few days of work. The very purpose of the Government Order is defeated by the candidates, who violate the bond conditions resulting in considerable shortage of Doctors in Government Medical Institutions across the State of Tamil Nadu, thereby depriving treatment to the poor patients, who all are taking treatment in Government Hospitals at free of cost."

Most significantly, what constitutes the actual cornerstone of this notable judgment is then laid bare succinctly in para 11 wherein it is mandated earnestly most decisively propounding that, "Providing decent medical treatment is an integral part under Article 21 of Constitution of India. The Government is duty bound to provide treatment to poor and the needy people, who all are admitted in Government Hospitals. If these Doctors after undergoing medical specialty courses, refusing to work in Government Hospital are infringing the fundamental right of the poor and needy patients, who all are undergoing treatment in Government Hospitals at free of costs. Thus, such an approach of the Doctors cannot be appreciated, since medical profession is a noble profession and the conduct of the Doctors must be in consonance with the Rules made by the Medical Council of India and the Government. Tax payers money in huge are spent for the doctors to undergo Post Graduate Medical Courses. Poor people contribute by paying tax in various forms."

Be it further noted that the Bench notes in para 12 that, "The National Medical Commission (erstwhile Medical Council of India Post Graduate Medical Education Regulation, 2000) has stipulated the following conditions with reference to the training programme of Post Graduate students.

Clause 13.2

"All the candidates joining the Post Graduate training programme shall work as 'Full Time Residents' during the period of training and shall attend not less than 80% (Eighty Percent) of the imparted training during each academic year including assignments, assessed full time responsibilities and participation in all facets of the educational process."

NMC Norms clearly indicate that patient care during the study period is part of their post graduate training programme."

17. .....service rendered by the petitioners during the post graduate study period, is considered as training period as per NMC norms. The petitioners are required to attend patients to gain practical knowledge. Since patient care is part of the post graduate training programme, the petitioners were assigned duty of treating and controlling the spread of COVID, including managing Pregnant Mothers who were affected by COVID during their study.

18. The petitioner during their PG period have done COVID duty outside their concerned Specialty during their period of study. Apart from their routine PG curriculum the Post Graduates were allotted COVID duty in turns as per the needs of the institution where they where studying. ...COVID duty is nothing but patient care, which was a National Emergency and the same is a part of the PG training programme as stipulated in the (Erstwhile Medical Council of India, Post Graduate Medical Education Regulation, 2000) and as such, the same cannot be equated to service being rendered by candidates after completing the course. The period of COVID duty done by the Medical Officers after the completions of their PG courses alone will be treated as Bond Service and the service rendered by the Post Graduates during the PG courses can be considered as study period only. Hence, the request of the petitioners to consider their COVID duty done by them during the study period cannot be accepted.""

For clarity, the Bench clarifies in para 13 stating that, "However, the order relied on by the petitioners, the above aspects and the principles were not considered. Therefore, the said order cannot be followed as a precedent for the purpose of deciding these cases. The legal precedent is to be considered with reference to the facts in particular and in the absence of consideration of legal principles, though facts are similar, cannot be construed as precedent."

Needless to say, the Bench states in para 14 that, "The ratio of any decision must be understood in the background of the facts of that case. It has been said long time ago that a case is only an Authority for what it actually desires and not what logically follows from it."

It is worth mentioning that the Bench observes in para 15 that, "The doctrine of binding precedent has the merit of promoting certainty and consistency in judicial decision, and enable organic development of law, besides providing assurance to the individual as to the consequence of transactions forming part of its daily affairs."

Quite significantly, the Bench points out in para 16 that, "A decision is available as a precedent only if it desires a question of law. Precedence which enunciate the Rules of law formed the foundation of administration of justice under the system. The reason of the Rule, which makes a precedent binding lies in the desire to secure uniformity and certainty of law."

For sake of clarity, the Bench clarifies in para 17 stating that, "Regarding the judgments of the constitutional courts, the judgment must be real as whole and the observation from the judgment have to be considered in the light of the questions, which were before the court concerned."

It merits mentioning that the Bench clearly states in para 18 that, "Even the Government is not justified in reducing the bond period from two years to one year. However, these Specialty Doctors and their services are to be utilized to the optimum level for the welfare of the patients treated at Government Hospitals."

Most forthrightly, the Bench then postulates in para 19 that, "In view of the fact that the petitioners have admittedly signed the bond and accepted the terms and conditions stipulated therein, they are not entitled to claim any concession for further reduction of period stipulated under the bond conditions. Therefore, the petitioners have to serve in Government Medical College and Hospitals as per the appointment order in compliance with the conditions and after completion of the period stipulated, appropriate decision may be taken by the respondents."

Finally, the Bench then aptly concludes by directing in para 20 that, "Accordingly, this Writ Petition stands dismissed at the admission stage itself. No costs. Consequently, connected miscellaneous petitions are closed."

All told, we need to definitely concede that Madras High Court has been most candid in pointing out forthrightly that specialist doctors refusing to work in government hospitals are infringing fundamental rights of the poor and the needy patients. So it is a no-brainer that the specialist doctors must pay heed to what has been held so laudably by the Madras High Court and adhere to what has been held in totality. No denying it!