In a landmark judgment, the Kerala High Court has struck down a state government order mandating that foreign medical graduates (FMGs) pay an internship fee to undertake the Compulsory Rotating Medical Internship (CRMI) in Kerala. The court's decision underscores the primacy of national medical regulations over state-level directives and reinforces the rights of FMGs to equal treatment during their internship period.
The controversy began with a Government Order (GO) issued by the Kerala Health Department on April 3, 2025, which stipulated that FMGs must pay a monthly fee of ₹5,000 to undertake their mandatory internship in the state. This directive was challenged by several FMGs, who contended that the imposition of such a fee was in direct contravention of the National Medical Commission (NMC) Act. The NMC, as the apex body governing medical education and practice in India, mandates that medical interns, including those from foreign institutions, should receive a stipend for their services and not be charged any fees.
The petitioners argued that the state government's order violated the NMC's policy, which explicitly prohibits the charging of internship fees to FMGs. They further contended that the imposition of such fees was discriminatory, as Indian medical graduates undergoing the same internship were not subjected to any fee. The petitioners also highlighted that the NMC had issued clear directives to all state medical councils and institutions, emphasizing the need for uniformity in the treatment of FMGs, including the provision of stipends and the prohibition of any fees for internship.
In its defense, the Kerala government argued that the NMC's directives did not have the force of law and that state governments retained the authority to impose such fees. The state contended that the NMC's role was advisory and did not extend to overriding state legislation or administrative decisions. However, the court found this argument unconvincing, emphasizing that the NMC, established under an Act of Parliament, holds statutory authority and its guidelines are binding on all state medical councils and institutions.
Justice N. Nagaresh, delivering the judgment, observed that the state government's order was not only inconsistent with the NMC's directives but also violated the principles of equality enshrined in the Constitution of India. The court noted that the imposition of a fee on FMGs, while exempting Indian medical graduates from the same, created an unjustifiable disparity and amounted to discrimination. The judgment further highlighted that the NMC's policy aimed to ensure that all medical interns, irrespective of their place of education, receive equal treatment, including the provision of stipends and exemption from internship fees.
The court's decision has been hailed as a significant victory for FMGs, who often face numerous challenges in pursuing their medical careers in India. Many FMGs, particularly those from economically disadvantaged backgrounds, had expressed concerns that the imposition of an internship fee would place an additional financial burden on them, potentially hindering their ability to complete their mandatory internship and obtain registration to practice medicine in India.
This ruling aligns with previous decisions by the Kerala High Court, which have consistently upheld the rights of FMGs. In 2021, the court ruled that FMGs who have completed their internship abroad and passed the Foreign Medical Graduate Examination (FMGE) should not be compelled to undergo another internship in India to obtain permanent registration. The court emphasized that such a requirement was inconsistent with the provisions of the Indian Medical Council Act and the Regulations framed thereunder.
The Kerala government's decision to impose an internship fee was part of a broader trend observed in some states, where FMGs were subjected to additional financial obligations not imposed on their Indian counterparts. These practices had led to widespread protests and legal challenges, culminating in the Kerala High Court's recent judgment.
The court's ruling is expected to have far-reaching implications, not only in Kerala but across India. It sends a clear message to all state governments that any policy or directive that discriminates against FMGs or violates the NMC's guidelines will not be upheld by the judiciary. The judgment also reinforces the need for uniformity and fairness in the treatment of all medical graduates, ensuring that the path to medical practice in India is equitable and accessible to all, irrespective of the country where their medical education was obtained.
In conclusion, the Kerala High Court's decision to annul the state's order imposing an internship fee on FMGs is a significant step towards ensuring equal treatment and opportunities for all medical graduates in India. The ruling underscores the importance of adhering to national medical regulations and upholding the constitutional principles of equality and non-discrimination. It is hoped that this judgment will serve as a precedent for other states, promoting a more inclusive and just medical education system in the country.
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