SC reiterates direction to National Medical Commission to revise disability guidelines

On 21 February, a Division Bench comprising Justices B.R. Gavai and K.V. Viswanathan recorded its reasons for its judgement in Anmol v Union of India, pronounced on 12 December last year. The judgement had directed the admission of Anmol, the appellant, in a seat reserved for Persons with Disability (PwD)(OBC) at the Government Medical College in Sirohi, Rajasthan. 

Authored by Justice Viswanathan, the judgment reiterates some of the progressive doctrines laid down by the Court in a few recent disability-related cases. The next hearing in the case is on 3 March, and the Court is expected to continuously monitor how the National Medical Commission revises its Guidelines for admission of candidates with disability. 

In the present case, Anmol, the appellant, had a distinguished academic record in school. His medical condition is as follows: “Locomotor disability 50 percent with club foot right lower limb with Phocomalia, Left middle ring finger through middle phalanx with right middle index finger through middle phalanx.” Further, his speech disability amounts to 20 percent. His final disability was assessed to be 58 percent. 

Anmol appeared for the NEET-UG 2024 Examination on 5 May last year. He obtained a rank of 2462 in the PwD category, which was well above the cut-off for the OBC-PwD category. The Disability Assessment Board, Chandigarh, however, rendered him ineligible to pursue a medical course. Then, the Punjab and Haryana High Court dismissed Anmol’s petition requesting quashing of the disability certificate issued by the Board. The High Court concluded that it could not substitute the opinion of the experts in the field of disability. 

When Anmol appealed this decision, the Supreme Court set up a six-member committee to examine whether the disability would come in the way of medical studies. Five members concluded that Anmol could not be declared fit to pursue MBBS under the current NMC Guidelines. They did note that the Guidelines “perhaps needed revision.” 

The ‘functional assessment’ focus in Om Rathod 

The Gavai-Viswanathan bench, however, found merit in the dissent recorded by the sixth member, Dr. Satendra Singh, a medical professional and an activist with disability. The bench had earlier requested the director of the All India Institute of Medical Sciences (AIIMS) to include Singh in the committee. 

The Court had reasons to trust Singh, who has previously contributed to the Court’s disability jurisprudence in Om Rathod v Director General of Health Services (2024). In that case, the appellant, who had a lower limb myopathy exceeding 80 percent, had been denied a seat after a medical assessment. The candidate challenged the findings, arguing that the boards did not include experts on disability and that the process failed to account for his functional capacity. 

In Om Rathod, the Court had appointed Singh to reassess the candidate. Singh had filed a report which contrasted sharply with the approaches of the AIIMS panel. It included a record of personal interaction with the appellant to understand their limitations, functional assessments and suggestions for safe accommodations. Singh concluded that the appellant was eligible to pursue the undergraduate medical course, aided by assistive devices. 

The bench, led by then CJI D.Y. Chandrachud, had accepted Singh’s report and noted the issue of “overmedicalization of disabled bodies by the assessment boards.” CJI Chandrachud had further observed that an approach which focuses more on disability than ability amounts to a denial of the right to reasonable accommodation and violates Articles 14, 19 and 21 of the Constitution. Consequently, he directed the respondent to issue fresh guidelines on the eligibility of PWDs in line with contemporary disability advancements and court decisions. Further, he directed that assessment boards include doctors or health practitioners who have disabilities themselves. 

‘Both hands’ mandate is outdated

In Anmol, Singh’s report concluded that the candidate could successfully navigate the MBBS course with clinical accommodations and assistive technologies. The bench noted that two judgments delivered in October last year (Om Rathod and Omkar Ramchandra Gond) had clearly mandated revision of the NMC Guidelines as the existing ones did not provide for functional assessment.

The Gavai-Viswanathan bench found that a functional assessment was not borne out by the report of five members. Secondly, the five members did not assign any reasons for denying Anmol his right to pursue the course. Thirdly, the bench concluded that the need to assess beyond the quantified disability and the need to opine whether the individual can enter the MBBS programme, aided by modern scientific tools and devices, had not been fulfilled by the five members of the Board.  

The bench reiterated that courts have the jurisdiction to ensure that the manner in which the Board functions follows the established principles of law. “We will only add that it is not just a question of jurisdiction of the court, but a duty cast upon the Court, since it is the Courts which enforce the fundamental rights,” Justice Viswanathan wrote, citing Om Rathod. 

The bench found it curious that while Anmol’s disability of 58 percent rendered him eligible for medical course under the PwD quota, what rendered him ineligible is the following note in the NMC Guidelines: “Both hands intact, with intact sensations, sufficient strength and range of motion are essential to be considered eligible for medical course.” 

The bench noted that this “both hands intact” stipulation had been expressly rejected by the Court in Om Rathod—such an insistence in a statutory regulation was antithetical to the objectives of Article 41, the principles set out in the United Nations Convention and the rights guaranteed under the Rights of Persons with Disabilities (RPwD) Act, 2016. 

The Court held that a prescription such as “both hands intact….” reeks of ableism, had no place in statutory regulation and made a mockery of the principle of reasonable accommodation. The judges agreed with Singh that it would be unfair to presume incompetence at the threshold without providing an opportunity to the candidate and ensuring the availability of accommodations and assistive products. “It is up to him, after completing MBBS, to decide whether he wishes to specialize in a non-surgical or medical branch or continue as a general duty medical officer,” the bench quoted Singh as saying in his report. 

The bench further observed that Singh’s report brought attention to the fact that NMC Guidelines still insist on the “both hands intact with intact sensations” norm in an age of robotic surgeries. The judgment also notes Singh’s observation that Harvey Cushing, known as the father of neurosurgery, had, in as early as November 1911, emphasised that motor skills are often “the least part of the work.” 

Flexibility is central to ‘reasonable accommodation’

The 21 February judgement is noteworthy for reiterating the principle of reasonable accommodation, laid down in the previous cases. Reasonable accommodation, as defined in section 2(y) of the RPwD Act, should not be understood narrowly to mean only the provision of assisting devices. In Vikash Kumar v UPSC (2021), the Supreme Court held that the principle of reasonable accommodation captures the positive obligation of the State and private parties to provide additional support to persons with disabilities to facilitate their full and effective participation in society.     

Paragraph 46 of Omkar Ramchandra Gond notes that “Disabilities Assessment Boards are not monotonous automations to just look at the quantified benchmark disability as set out in the certificate of disability and cast aside the candidate.” The Boards are obliged to examine, with expert assistance, whether the disability will come in the way of the candidate pursuing the course in question. 

The bench in Anmol added that flexibility in answering individual needs and requirements is an essential component of reasonable accommodation.  

This tracks the observation in Vikash Kumar that “the accommodation which the law mandates is ‘reasonable’ because it has to be tailored to the requirements of each condition of disability.” 

On 3 March, the bench will have an opportunity to satisfy itself that the NMC has constituted a new committee of domain experts to revise the current Guidelines. In Om Rathod, the Court had directed that such a committee should include persons with disability or one or more experts conversant with disability rights.