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Friday, June 6, 2003

Medicos against privatisation

Medicos against privatisation


Medical students in Tamil Nadu, backed by their seniors in the profession, resist bitterly what they see as moves that would dilute the quality of medical education and produce a surfeit of doctors as a result of the setting up of more medical colleges in the private sector.


A demonstration by agitating medical students in Chennai on April 28.

A LARGE section of the medical fraternity in Tamil Nadu, including principally about 12,000 medical students, is pitted against the State government over the issue of the virtual privatisation of medical education. The students, who initiated the struggle, have made another important demand: the scrapping of a quota of seats for non-resident Indians (NRIs) in government medical colleges, to which admissions are made on the basis of a higher payment structure. The students' agitation, which entered the 27th day on May 19, has the backing of the Tamil Nadu Government Doctors' Association. Doctors in government service pursuing their postgraduate education have joined the protest.

According to a Government Order dated August 13, 2001 issued by the State Health and Family Welfare Department, since "it would be prohibitively expensive to open more number of colleges in the state sector", it has been "decided to consider the request of the private organisations for the request of NOC (no-objection certificate) to start medical and dental colleges in backward areas". The government directed the Director of Medical Education (DME) "to consider the requests of private organisations for issue of essentiality certificate to start medical/dental colleges in the backward/rural areas of the state... "

The students termed the G.O. "an invitation to open private medical and dental colleges" and expressed the fear that such institutions would proliferate, in the process bringing down the quality of medical education. The vice-president of the Tamil Nadu Medical and Dental Students' CRRIs', Senior House-Surgeons' and Postgraduate Doctors' Association, D. Karal, said: "Seats will be sold for Rs.25 lakhs to Rs.35 lakhs. People with money will buy them... " After private organisations were allowed to start engineering colleges, more than 230 such colleges had sprung up in the State leading to dilution of standards in education. "This should not happen in medical education because it is tantamount to playing with the life of patients," said Karal. This Association is spearheading the agitation. (CRRI stands for Compulsory, Rotatory Residential Internship).

One of their key demands relates to barring new private medical and dental colleges by law. The essentiality certificate given by the government to the Meenakshi Ammal Trust, Chennai, to start a medical college near Kancheepuram, triggered the trouble.

State Health Minister S. Semmalai said that the power to clear private medical colleges lay with the Centre, not the States. "Despite the existence of the G.O., no essentiality certificate has been issued to any private medical or dental college by this government. The Meenakshi Ammal Trust received the essentiality certificate on the orders of the Supreme Court." The Madras High Court had directed that the Trust be given the certificate. The State government appealed against this in the Supreme Court, but the court upheld the High Court's order, Semmalai added.

The Minister said separately that in the matter of granting permission to set up private medical colleges, the State government's powers were limited compared to those of the Centre. The Supreme Court had specified these powers in a case filed by the Kirubananda Variar Medical Trust, he said. In another case, he said, the apex court had ruled that even when a State government refused to give permission for a dental college being started, the Dental Council of India could take a decision. He contended: "As per the Supreme Court ruling, only the Centre had the powers to permit private medical colleges to come up. It is meaningless for the students to agitate against the State government when they should be protesting against the Centre, which has the power to sanction private medical colleges... "

But the students insist that the State government has the power to block new colleges, for the power to grant no-objection and essentiality certificates were its. They point out that the Supreme Court had said a mere policy decision by a State government not to allow private medical colleges would not do; there should be a law to back such a decision.

There are 11 government-run medical colleges and one government dental college in Tamil Nadu. These 12 colleges offer about 1,120 seats. Besides, there are six private medical colleges and 11 private dental colleges. The government recently announced that it will set up medical colleges at Theni, Vellore and Nagercoil.

After two rounds of talks between Semmalai and the students' leaders failed on May 17, the government acted tough. About 5,000 medicos were suspended. Of them more than 1,200 would not be allowed to sit for their examinations beginning in the first week of June, he said. Undaunted, the students asserted that their agitation would continue.

When the medicos launched a token strike on April 9, their demands, other than that relating to privatisation, were that the State government should get Medical Council of India (MCI) recognition for the MBBS course offered by the K.A.P. Viswanatham Government Medical College in Tiruchi and the Thoothukudi Government Medical College, and postgraduate courses offered by the government medical colleges, and provide more facilities in the Government Dental College, Chennai. The government was also requested to withdraw the increase in fees for postgraduate medical courses and restore the 10 per cent increase in stipend for MBBS and BDS students during their one-year period of internship.

Subsequently, the agitators discovered the existence of the G.O. of August 13, 2001, which they felt smacked of a privatisation drive. According to the G.O., the government had reviewed the guidelines and constituted a committee to suggest norms for the issue of essentiality certificates to private organisations to start medical and dental colleges in backward areas.


State Education Minister S. Semmalai in discussion with the representatives of medical students at the Secretariat in Chennai.

The G.O. said: "The starting of new institutions would go a long way in improving the medical facilities in these areas. A large number of students from the State are going to neighbouring States to pursue medical studies and the students will be able to pursue their studies nearer to their homes." The G.O. mentioned that while the Ninth Plan target was a doctor-patient ratio of 1:1000, the present doctor-patient ratio in Tamil Nadu was 1:2000. "Due to the present ratio, shortage of doctors in the rural areas is felt," it stated.

However, according to Dr. R.M. Krishnan, chairman of the ethics committee of the Indian Medical Association, Tamil Nadu unit, the doctor-patient ratio in Tamil Nadu has reached saturation point. He said that there were 6,000 unemployed or underemployed doctors in the State. According to Karal, the WHO-stipulated doctor-patient ratio is 1:3,500 while in Tamil Nadu it is 1:1000. There were 67,000 registered doctors in Tamil Nadu for its population of 6.2 crores, Karal said.

The students insisted on the withdrawal of the August 13 G.O. When the government failed to provide any assurance on the matter, they launched the strike on April 23. They demonstrated before the office of the Director of Medical Education. They squatted on the road and blocked traffic. They observed a silent protest. They wore masks. They donated blood and ran makeshift outpatient centres.

Dr. K. Prakasam, president, Tamil Nadu Government Doctors' Association, announced the association's support to the students. Its members struck work on May 9. The doctors are planning to start an indefinite strike from May 21.

The government warned the doctors that the Essential Services Maintenance Act (ESMA) would be invoked against them. It transferred Dr. Prakasam and several other doctors. Yet the doctors struck work on May 9 and then on May 14. As they intensified their agitation, patient care was hit in government hospitals. Wards remained empty, and many poor patients were affected.

Medical students in Tamil Nadu have had an extended record of opposing the setting up of private medical and dental colleges. "We started our agitation against privatisation in 1989. In February 2000, we struck work for more than two weeks, expressing our protest against privatisation," Karal recalled.

The fate of their agitation this time around remains uncertain in the face of the seemingly inflexible stand taken by the All India Anna Dravida Munnetra Kazhagam government in the State.


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