SC Directs Tripura Medical College To Admit Two CVD-Affected Students Who Qualified Before NEET Under Its “Transcendental” Jurisdiction [Read Order]

Two students, suffering from Colour Vision Deficiency (CVD), have succeeded in convincing the Supreme Court that they could not be disqualified from seeking admission to the MBBS course, on the ground of their CVD.

On September 12, the bench of the Chief Justice, Dipak Misra, and Justices Amitava Roy and A.M.Khanwilkar, overruled the objections of the Medical Council of India (MCI) and the Tripura Medical College, where they sought admission, and directed the authorities to give them seats in the college, in 2018-19, reducing the College’s quota of seats by two.

The two students, Pranay Kumar Poddar and Sagar Bhowmik, had cleared the entrance examination conducted by the Tripura Government in 2015 by securing 112 and 140 ranks.  MCI and the College had opposed their admission, because they qualified before the NEET examination was introduced last year, and they insisted that they should be asked to clear the NEET examination afresh.

The Supreme Court, however, rejected their contention, and directed their admission, using its powers under Article 142 of the Constitution, which it described as the “transcendental importance of justice”, -which is writ large in this case – and in the peculiar facts and circumstances of the case.

Earlier, in March, the Court had directed the MCI to set up a Committee of experts, from genetics, ophthalmology, psychiatry and medical education, to study the international practices and answer specific questions regarding the eligibility of CVD-affected students for admission to the MBBS course.  The committee comprised of 10 members, including K.V.Vishwanathan, Amicus Curiae in the case, and Shoeb Alam, Advocate on Record, Supreme Court of India.

BACKGROUND

In its March judgment, the SC had held that total exclusion for admission to medical courses without any stipulation in which they really can practice and render assistance would tantamount to regressive thinking.  The march of science, the Court held, apart from our constitutional warrant and values, commands inclusion, and not exclusion.

The two candidates were declared ineligible to take admissions to MBBS course in the counselling held on June 23, 2015 in Tripura, on the premise that , they suffered from partial colour blindness. These students approached the High Court of Tripura at Agartala in a civil writ petition (No.244 and 252 of 2015) and sought relief that the declaration of ineligibility by the concerned committee was absolutely indefensible and legally impermissible.

The appellants submitted that there were no regulations by the Medical Council of India under the Indian Medical Council Act, 1956, that debarred candidates like them from admission to MBBS course, and for in the absence of such a regulation, neither any instruction nor resolution of the MCI could throttle their right to appear and get admitted.

The High Court took the view that it should not interfere solely on the ground that the MCI’s Regulations are silent with regard to the denial of admission to an individual suffering from colour blindness.  It, therefore, dismissed the writ petitions.

The report of the expert committee constituted by the Court through the MCI, concluded that there is limited evidence about the impact of colour vision deficiency on the diagnostic, medical and surgical skills of medical professionals.

After examining the international practices, the Committee answered the questions referred by the Court, as follows:

1. Colour vision deficiency is not and should not be an absolute bar in the medical profession.


2. There should not be any restriction either at the stage of admission to the course, or at the stage of completion of study/registration as a medical practitioner.


3. There should not be any restriction on the field of practice. However, individual subjects of higher studies/disciplines of super specialization may be asked to prepare and provide a list of tasks, if any that may not be performed/ may be difficult to perform by  practitioners with colour vision deficiency and state the alternatives/options to overcome the same.   This may be made available within a time frame by subject experts and supported by published literature.


4. As per existing knowledge and prevalent practice, there is no restriction on subjects for doctors with CVD.


5. As per current international practices, there is no policy of regulating entry of medical aspirants to study and practice of the medical profession based on CVD. There are also no identified or mentioned practice restrictions.


6. As per published literature and check list of duties of a doctor, there is no identifiable compromise in the abilities of a clinical practitioner with CVD.  However, in certain tasks pertaining to specific fields of higher studies and super-specialization, there is a likelihood of some compromise in abilities of practitioners with total colour blindness to function at par with those with normal colour vision or partial CVD.  This may require some level of awareness of the individual about possible problems with self-regulation or restriction.  As a matter of abundant precaution, such situations should be individually assessed by concerned subject experts.


7. Colour correction lenses worn either as Colour corrective contact lenses or spectacle may be considered to assist the person if and when necessary


8. Information can be collected from health care professionals working in India planning a multicentre collaborative study.

In conclusion, the committee opined that the evidence generated clearly points to the need for screening for CVD in medical students and doctors.  Assessment of severity of CVD and subsequent counselling will improve decision making for an informed choice of career, it suggested.

Doctors with known CVD could choose from the wide range of specialties, and therefore, non-acceptance of applicants to medical school does not arise, the committee observed.

Doctors and other medical professionals will benefit by knowing the severity of their deficiency and this will lead to better work performance as those aware of their limitations will more likely, use corrective measures, it suggested.

Another expert in the committee, observed that people with CVD are not totally colour blind.  Rather their difficulties with colour vision range on a continuum from mild to severe levels of deficiency.  CVD is not uncommon in the general population.  Prevalence studies from the UK estimate congenital CVD to be present in 8 per cent of men and 0.5 per cent of women.  People with CVD learn to adapt to their deficiency by using a variety of cues and assumptions to guess the colour of the object they are seeing.   There is a lack of consensus across different professions about how best to determine vocational suitability  of those with CVD, the expert added.

With proper awareness, adequate help and sustained effort, most students and doctors should be able to overcome any difficulties arising from the CVD.   Though there is no strong evidence that physicians with CVD miss important signs of medical illnesses, those with severe CVD who are unaware of their deficiency are at an increased risk of committing errors, the experts have found.

While patient welfare and safety are important considerations, care has to be taken to balance patient-related concerns with sensitivity for doctors afflicted with CVD and proper regard for their right to be treated fairly and their right to pursue their choice of careers, another expert suggested.

However, screening at the undergraduate and postgraduate level, with the use of appropriate tests, assumes importance for Indian students, because unlike the standard practice in the West, people with CVD in India are less likely to have been screened at any earlier stage, it was pointed out.

Those who screen positive should be tested more extensively to determine the nature and severity of their CVD, the difficulties they are likely to encounter in their training, their awareness of the condition and the psychosocial impact of their CVD, it was proposed.

The choice of the specialty should be tailored to the severity of CVD, the extent of difficulties in performing clinical tasks related to that speciality, and the needs and expectations of the individual trainees.  It can be hoped that with proper education and counselling most doctors will be able to make an informed and appropriate choice of the medical specialty they want to practise, one of the experts had observed.

In conclusion, the committee had held that CVD does not have any embargo of any type whatsoever.