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2021 DIGILAW 931 (KER)

Jahnavi B Patel, D/o Bharat K. Patel v. Travancore - Cochin Council Of Modern Medicine

2021-10-11

P.B.SURESH KUMAR

body2021
JUDGMENT : Petitioner, a citizen of India, born to parents residing permanently in the State of Kerala is aggrieved by Ext.P19 public notice and Ext.P20 order issued by the first respondent in terms of which the application preferred by the petitioner for permanent registration with the first respondent as a medical practitioner has been rejected. 2. The petitioner, after clearing the Senior School Certificate Examination from a school affiliated to the Central Board of Secondary Education, went to the United States of America to do the Pre-Medical course in the University of California, San Diego which is required for obtaining medical qualification from a medical institution in the United States of America. After successful completion of the Pre-Medical course, during September 2013, the petitioner joined Avalon University School of Medicine (Avalon School of Medicine), in the island nation of Curacao in the Caribbean for the four year MD Medical Programme. It is stated by the petitioner that Avalon School of Medicine is a medical institution recognised by the then Medical Council of India (Medical Council of India) and the MD Medical Programme of the said medical institution is equivalent to the MBBS course in India. It is also stated by the petitioner that the MD Medical Programme of Avalon School of Medicine is designed in such a manner that students will be taught the basic science part of the curriculum in the first sixteen months of the programme in the campus of the medical institution and thereafter, they will have to do a bridge course of five weeks in one of the hospitals affiliated to the medical institution so as to enable them to learn the clinical science part of the curriculum. It is stated that the students will be required thereafter to do 72 weeks of clinical rotations in one of the hospitals in the United States of America affiliated to the medical institution. It is also stated that the curriculum of the course is designed in such a manner that upon successful completion of the course, the students would be entitled to register for the United States Medical Licensing Examination (USMLE) which is necessary for practising medicine in Curacao. The petitioner completed the clinical rotations at Phoenix in the United States of America and later graduated from the medical institution on 30.8.2017. She has thereafter cleared the USMLE during January, 2018. The petitioner completed the clinical rotations at Phoenix in the United States of America and later graduated from the medical institution on 30.8.2017. She has thereafter cleared the USMLE during January, 2018. Ext.P4 is the certificate issued to the petitioner in this regard by the Educational Commission for Foreign Medical Graduates of the United States of America. 3. After the graduation, the petitioner decided to return to India, and on her return, with a view to practice medicine in India, the petitioner appeared for the Foreign Medical Graduate Examination conducted by the National Board of Examinations during December, 2017 and cleared the said examination in the first attempt itself. The petitioner thereafter obtained provisional registration from the first respondent on 10.12.2018 and completed the Compulsory Rotatory Residential Internship (CRRI) devised by the Medical Council of India in terms of the provisions contained in the Indian Medical Council Act, 1956 (IMC Act) which was insisted by the first respondent for the petitioner to seek permanent registration with them as a medical practitioner in the State of Kerala. Ext.P9 is the certificate of internship issued to the petitioner by the Amrita Institute of Medical Sciences, Kochi. 4. On the basis of Ext.P9, the petitioner applied to the first respondent for permanent registration with them in terms of the Travancore-Cochin Medical Practitioners Act, 1953 (TCMP Act). Ext.P10 is the application preferred by the petitioner in this regard. Earlier on 20.9.2019, the first respondent issued a public notice to the effect that registration will not be granted to medical graduates who have obtained medical qualification through off-campus education method from any medical institution outside India. Ext.P19 is the public notice issued by the first respondent in this regard. Earlier on 20.9.2019, the first respondent issued a public notice to the effect that registration will not be granted to medical graduates who have obtained medical qualification through off-campus education method from any medical institution outside India. Ext.P19 is the public notice issued by the first respondent in this regard. Ext.P10 application has been rejected by the first respondent stating among others, that (i) the petitioner has obtained medical qualification from a medical institution outside India through off-campus education method; that (ii) Avalon School of Medicine was not recognised by the Medical Council of India at the time when the petitioner joined for the MD Medical Programme in the said medical institution and the petitioner was therefore not entitled to the Eligibility Certificate to obtain medical qualification from the said medical institution which was mandatory for the petitioner to obtain medical qualification from any medical institution abroad and also to undertake the Screening Test provided for in terms of Section 13(4A) of the IMC Act and (iii) that the petitioner has not produced any documents to establish that the medical qualification granted to her by the Avalon School of Medicine is recognised for enrolment as medical practitioner in Curacao. Ext.P20 is the order issued by the first respondent in this regard. Exts.P19 public notice and P20 order are under challenge in the writ petition. The petitioner also seeks a declaration that she is entitled to the registration sought by her. 5. A statement has been filed by the first respondent reiterating and elaborating the stand taken by them in Ext.P20 order. Along with the statement, the first respondent has produced as Ext.R1(b) resolution adopted by them on 20.09.2019, on the basis of which Ext.P19 public notice was issued. 6. Heard the learned counsel for the petitioner as also the learned Standing Counsel for respondents 1 and 2. 7. The learned counsel for the petitioner asserted, placing reliance on the uncontroverted pleadings in the writ petition that the MD Medical Programme pursued by the petitioner is not an off-campus programme and Ext.R1(b) resolution cannot, therefore, have any application to the case of the petitioner. It was also argued by the learned counsel alternatively that the first respondent has no authority to adopt a resolution in the nature of Ext.R1(b), especially in so far as the same is contrary to the provisions of the IMC Act. It was also argued by the learned counsel alternatively that the first respondent has no authority to adopt a resolution in the nature of Ext.R1(b), especially in so far as the same is contrary to the provisions of the IMC Act. It was also argued by the learned counsel alternatively that in so far as the petitioner has completed the course during the year 2017, cleared the qualifying examination for practice in Curacao, cleared the Screening Test conducted by the Medical Council of India in terms of Section 13(4A) of the IMC Act and obtained provisional registration from the first respondent long before Ext.R1(b) resolution, the same, at any rate, does not apply to her case. In support of the said contention, the learned counsel relied on the decisions of this Court in W.P.(C) No.2344 of 2020 and W.A.No.1667 of 2020, affirming the decision in W.P.(C) No.2344 of 2020. It was also argued by the learned counsel that at any rate, in so far as the petitioner has been granted provisional registration by the first respondent for the purpose of undergoing the CRRI, even though the same was not required to be undertaken by her, the first respondent is estopped from taking the stand that the petitioner is not entitled to permanent registration. It was also pointed out by the learned counsel that Avalon School of Medicine was though a medical institution recognised by the Medical Council of India, on 17.09.2012, the Medical Council of India decided not to issue Eligibility Certificate in terms of Section 13(4B) of the IMC Act for obtaining medical qualification from the said medical institution as it entertained a doubt then as to whether the medical qualification of that medical institution is one recognised in Curacao. It was also pointed out by the learned counsel that later having found that the medical qualification granted by Avalon School of Medicine is one recognised in that country, the Medical Council of India has revoked its early decision on 21.08.2014. According to the learned counsel, in the said circumstances, the stand taken by the first respondent for declining the registration sought by the petitioner on the ground that the medical institution from which the petitioner obtained medical qualification was not one recognised by the Medical Council of India at the time when the petitioner joined for the medical course, is unsustainable. It was also asserted by the learned counsel based on the materials on record that the petitioner is entitled to practice medicine in Curacao on the strength of Ext.P4 certificate issued by the Educational Commission for Foreign Medical Graduates, United States of America. 8. Per contra, the learned Standing Counsel for the first respondent submitted, at the outset, that the petitioner has an effective alternative remedy against Ext.P20 order by way of appeal before the Government under Section 35 of the TCMP Act and the writ petition is therefore not maintainable. It was also argued by the learned Standing Counsel that the pleadings of the petitioner itself would show that the MD Medical Programme pursued by the petitioner is an off-campus course, insofar as the petitioner has admittedly not pursued the clinical science part of the curriculum of the programme at the medical institution. The learned Standing Counsel has strongly refuted the stand taken by the learned counsel for the petitioner that Ext.R1(b) is invalid. It was pointed out that resolutions in the nature of Ext.R1(b) are taken in public interest and in the absence of any provision in the TCMP Act precluding the first respondent from taking such decisions, the same cannot be said to be invalid. As regards the decisions of this Court in W.P.(C) No.2344 of 2020 and W.A.No.1667 of 2020, it was pointed out that the operation of both the said judgments have been stayed by the Apex Court in terms of Ext.R1(d) order. It was also submitted by the learned counsel that the petitioner has admittedly not obtained the Eligibility Certificate in terms of Section 13(4B) of the IMC Act which was mandatory for the petitioner to undertake the Screening Test provided for in terms of Section 13(4A) of the IMC Act. According to the learned Standing Counsel, the explanation offered by the petitioner for the said omission is that the said requirement was suspended during the relevant period in which she joined the medical institution abroad. It was pointed out that the stand of the petitioner that but for the suspension of the said requirement, the petitioner would have obtained the Eligibility Certificate cannot be accepted insofar as the medical institution was one not recognised by the Medical Council of India at the relevant time and the petitioner would not have been issued Eligibility Certificate even if there was no suspension of the requirement. According to the learned Standing Counsel, it can therefore be seen that the petitioner was not eligible to appear for the Screening Test. It was also asserted that the materials on record do not indicate that the petitioner was entitled to practice medicine in Curacao on the strength of Ext.P4 certificate issued by the Educational Commission for Foreign Medical Graduates, United States of America. In addition, the learned Standing Counsel has highlighted the danger in permitting persons who have obtained medical qualification in off-campus education method to practice medicine. According to the learned counsel, it was observed by the first respondent that such persons are ill equipped and granting registration to them will not be conducive to public interest. 9. On a query from the Court, the learned Standing Counsel for the second respondent submitted that no restrictions whatsoever have been imposed by the Medical Council of India in the matter of pursuing medical course abroad in off-campus education method. It was, however, pointed out that a proviso was added to Regulation 9 of the Eligibility Requirement for Taking Admission in an Undergraduate Medical Course in a Foreign Medical Institution Regulations, 2002 to the effect that in order to obtain provisional/permanent registration on the strength of Eligibility Certificate and the qualification in the Screening Test, the candidate shall have to pursue the medical course for the entire duration in the medical institution from where he/she has obtained the medical qualification. 10. I have considered thoughtfully the various contentions advanced by the learned counsel for the parties on either side. 11. As noted, the petitioner is a person who has obtained medical qualification from a medical institution abroad during August, 2017 and who claims to have qualified to practice medicine in the country where the medical institution is situated during January, 2018. The petitioner admittedly has obtained provisional registration with the first respondent and completed the CRRI insisted to be undertaken by the first respondent, during February, 2020. The application preferred by the petitioner thereafter for permanent registration was disposed of only on 07.10.2020. True, in the light of Section 35 of the TCMP Act, the petitioner is free to challenge Ext.P20 order in an appeal before the State Government. The application preferred by the petitioner thereafter for permanent registration was disposed of only on 07.10.2020. True, in the light of Section 35 of the TCMP Act, the petitioner is free to challenge Ext.P20 order in an appeal before the State Government. The restriction that the High Court shall not entertain a writ petition against an order against which an appeal is provided for under the statute is a self imposed one and it is trite that the said restriction is not a bar in entertaining a writ petition in appropriate cases where this Court finds that the alternative remedy of appeal is not an efficacious one on facts. Insofar as the issue involved in this matter pertains to the fundamental right of the petitioner under Article 19(1)(g) of the Constitution, having regard to the case of the petitioner that she is not able to practice despite being qualified for the same as early as in the month of February 2018, according to me, it is obligatory for this court to examine the correctness of the impugned decision declining registration of the petitioner and to permit the petitioner to practice medicine in fulfilment of the fundamental right guaranteed to her under Article 19(1)(g), if she is entitled to registration. The contention taken by the learned Standing Counsel for the first respondent as regards the maintainability of the writ petition is therefore rejected. 12. As noted, the main ground on which the application of the petitioner for permanent registration was rejected by the first respondent is that the petitioner has obtained medical qualification from a medical institution abroad through off-campus education method. It is seen that the said stand is taken by the first respondent for the reason that the petitioner has completed the basic science part of the curriculum of the medical course in the campus of the medical institution and the clinical science part of the curriculum in one of the hospitals in the United States of America affiliated to the medical institution. Off-campus study is understood in general parlance as a study without being physically present in the educational institution. In the case on hand, the first respondent has no case that the petitioner has not attended the classes in the campus of the medical institution for the first sixteen months of the course during which term the students were taught the basic science part of the curriculum. In the case on hand, the first respondent has no case that the petitioner has not attended the classes in the campus of the medical institution for the first sixteen months of the course during which term the students were taught the basic science part of the curriculum. The first respondent has also no case that the petitioner has not undertaken the clinical science part of the curriculum in one of the affiliated teaching hospitals of the medical institution. In other words, the objection of the first respondent is that the petitioner has not pursued the entire medical course in the campus of the medical institution, styling such course of study as off-campus study. The petitioner does not dispute the said fact. According to the petitioner, such a mode of study cannot be styled as off-campus study. As pointed out by the learned counsel for the petitioner, no restriction whatsoever is imposed by the Medical Council of India in terms of the provisions contained in the IMC Act in the matter of any person obtaining a medical qualification from a medical institution abroad on the basis of a curriculum like the one prescribed by Avalon School of Medicine. Even the proviso to Regulation 9 of the Eligibility Requirement for Taking Admission in an Undergraduate Medical Course in a Foreign Medical Institution Regulations, 2002, to which the attention of the Court is drawn by the learned Standing Counsel for the second respondent, only provides that those persons who are seeking provisional/permanent registration with the State Medical Councils on the strength of the medical qualifications obtained by them from medical institutions abroad should have pursued their medical course in the same medical institution during the entire duration of the course. In other words, the scheme of the IMC Act and the Rules and Regulations made thereunder do not preclude a person who secures a medical qualification from a medical institution abroad, the curriculum of which is prescribed as in Avalon School of Medicine, from obtaining registration with any State Medical Council. It is all the more so since, Avalon School of Medicine is one recognised by the Medical Council of India even according to the first respondent with effect from 21.08.2014 and Eligibility Certificates are being issued by the Medical Council of India in terms of Section 13(4B) of the IMC Act for obtaining medical qualification from the said medical institution. It is all the more so since, Avalon School of Medicine is one recognised by the Medical Council of India even according to the first respondent with effect from 21.08.2014 and Eligibility Certificates are being issued by the Medical Council of India in terms of Section 13(4B) of the IMC Act for obtaining medical qualification from the said medical institution. In other words, the right of the petitioner to claim registration in terms of the provisions of the IMC Act cannot be doubted, especially since the petitioner has been granted provisional registration by the first respondent as provided for under Section 25(1) of the IMC Act. As a matter of fact, the first respondent also does not dispute the fact that the petitioner is entitled to registration in the State Medical Register in terms of the provisions of the IMC Act. If that be so, the question is whether the first respondent would be justified in denying registration to the petitioner who has obtained medical qualification from the said institution on the basis of the curriculum of the course of study undertaken by her, if she is otherwise entitled to registration in terms of the provisions of the IMC Act. 13. The requirement of law for practising medicine in terms of the IMC Act is that the name of the person concerned shall be entered in a State Medical Register. As far as the State of Kerala is concerned, the State Medical Register is the register of practitioners maintained by the first respondent in terms of TCMP Act. The scope of the power of the first respondent to deal with applications for registration in the register of practitioners maintained by them is as provided for in Section 23 of the TCMP Act. In terms of Section 23, every holder of a recognised medical qualification, who is not subject to any of the disqualifications provided therein, is eligible for registration. The Schedule to the TCMP Act in which the particulars of the recognised medical qualifications are furnished includes all medical qualifications recognised under the IMC Act also. In other words, a person who is entitled to registration in a State Medical Register in terms of the provisions of the IMC Act cannot be denied registration by the first respondent. The Schedule to the TCMP Act in which the particulars of the recognised medical qualifications are furnished includes all medical qualifications recognised under the IMC Act also. In other words, a person who is entitled to registration in a State Medical Register in terms of the provisions of the IMC Act cannot be denied registration by the first respondent. The stand of the first respondent that a person who obtains a medical qualification from a medical institution abroad where the curriculum is designed like the one prescribed by the Avalon School of Medicine, is not entitled to registration, is therefore invalid. 14. I shall now deal with Ext.R1(b) resolution on which reliance is placed by the first respondent to justify its stand that the petitioner is not entitled to registration in the light of the curriculum of the course undertaken by her. Even assuming that Ext.R1(b) resolution takes within its scope the curriculum prescribed by Avalon School of Medicine and that the first respondent is entitled to impose restrictions in the nature of one made in Ext.R1(b), the same cannot be given effect to in the case of the petitioner since she has been granted provisional registration long before Ext.R1(b) resolution. The reason being that the registration, both provisional and permanent, are granted for the purpose of practice and when those who are issued permanent registration prior to Ext.R1(b) resolution are permitted to practice, it would be wholly arbitrary and discriminatory to deny the same privilege to those who have secured provisional registration, for they cannot be treated differently. True, the question whether Ext.R1(b) resolution could be given effect to in the case of applications for registration filed prior to Ext.R1(b) resolution is pending consideration before the Apex Court in the proceedings instituted by the first respondent against the decision of the Division Bench of this Court in W.A. No.1667 of 2020, but the case involved in that matter stands on an entirely different footing as the party involved in that case is not a person who has been granted provisional registration prior to Ext.R1(b) resolution like the petitioner in the case on hand. 15. 15. Another ground on which the application of the petitioner for permanent registration was rejected is that Avalon School of Medicine was not recognised by the Medical Council of India at the time when the petitioner joined for the medical course in the said medical institution and the petitioner was therefore not entitled to the Eligibility Certificate to obtain medical qualification from the said medical institution, which was mandatory for the petitioner to obtain medical qualification from any medical institution abroad and also to undertake the Screening Test provided for in terms of Section 13(4A) of the IMC Act. The petitioner has admittedly not obtained the Eligibility Certificate in terms of Section 13(4B) of the IMC Act. The explanation offered by the petitioner for the said omission is that the requirement in terms of Section 13(4B) was suspended during the period when she joined for the medical course in the medical institution abroad. The stand of the first respondent is that insofar as Avalon School of Medicine was not recognised by the Medical Council of India at the time when the petitioner joined for the medical course in the said medical institution, the petitioner would not have been issued Eligibility Certificate even if there was no suspension of the requirement in terms of Section 13(4B) and therefore the petitioner was not eligible to appear for the Screening Test, the qualification of which is mandatory for the petitioner to seek registration as a medical practitioner, though she cleared the Screening Test. The petitioner does not dispute the fact that on 17.09.2012, the Medical Council of India decided not to issue Eligibility Certificate for obtaining medical qualification from Avalon School of Medicine as it entertained a doubt then as to whether the medical qualification of that medical institution is one recognised by Curacao. But, according to the petitioner, later on 21.08.2014, having found that the medical qualification of that medical institution is one recognised by the said country, the Medical Council of India revoked the decision taken on 17.09.2012. The first respondent does not dispute this fact. But, according to the petitioner, later on 21.08.2014, having found that the medical qualification of that medical institution is one recognised by the said country, the Medical Council of India revoked the decision taken on 17.09.2012. The first respondent does not dispute this fact. On the other hand, the crux of the stand taken by the first respondent is that in the light of the decision taken by the Medical Council of India on 17.09.2012, the petitioner was not entitled to the benefit of the suspension of the requirement of the Section 13(4B) of the IMC Act and was not eligible to undertake the Screening Test, being a person who has not obtained the Eligibility Certificate. The fact that the petitioner was permitted by the Medical Council of India to undertake the Screening Test and the fact that she has cleared the same is not disputed by the first respondent. Insofar as the petitioner has undertaken the Screening Test and cleared the same, according to me, the first respondent cannot consider the eligibility of the petitioner to undertake the Screening Test under Section 13(4A) of the IMC Act. True, there is nothing wrong in the State Councils examining the eligibility of a candidate to undertake the Screening Test while scrutinising the application for registration, but if it is found that a candidate has appeared for the Screening Test without there being any eligibility for the same, according to me, the State Councils can certainly bring the said fact to the notice of the Medical Council of India to initiate appropriate proceedings for recalling the result of the Screening Test. I take this view for the reason that in terms of the provisions of the IMC Act, it is for the Medical Council of India to consider whether a particular candidate is eligible to undertake the Screening Test and permit or decline to permit him/her to undertake the Screening Test. If it is held that the State Medical Councils are empowered to adjudicate the eligibility of a candidate who is seeking registration to undertake the Screening Test, the State Medical Councils will be able to nullify the results of the Screening Test conducted by the Medical Council of India collaterally, which would in turn affect the sanctity of the Screening Test, which is a statutory test. It is all the more so since the result of a candidate in the Screening Test cannot be meddled with without affording him an opportunity of hearing. The objection raised by the first respondent in the light of the decision taken by the Medical Council of India on 17.09.2012 in considering Ext.P10 application is therefore liable to be rejected on that sole ground. 16. It is seen that after Act 34 of 2001 in terms of which IMC Act was amended, the earlier concept of recognising the foreign medical institutions has been taken away and the scheme of the IMC Act thereafter is that a person who secures a medical qualification from a medical institution abroad is entitled to be enrolled in a State Medical Register if the said medical qualification is recognised in the country of education for enrolment as medical practitioner and if he/she clears the Screening Test. Of course, after Act 34 of 2001, such candidates are required to obtain the Eligibility Certificate in order to become eligible for obtaining medical qualification from any medical institution abroad and to undertake the Screening Test. In Ishan Kaul and others v. Medical Council of India and another, 2010 KHC 6491, referring to Act 34 of 2001, the Delhi High Court has clarified that the Eligibility Certificate in terms of Section 13(4B) of the IMC Act is not institution specific, but only student specific in the sense that it only certifies the eligibility of the student to undertake a medical course abroad, if he/she wants to come back to India and practice medicine after clearing the Screening Test. In Shambhavi Sharma v. National Board of Examinations and Another, 2010 SCC Online Del 4490, the Delhi High Court has held that merely for the reason that a person has not obtained Eligibility Certificate, he shall not be denied the right to undertake the Screening Test, if he is otherwise entitled to Eligibility Certificate. In the light of Act 34 of 2001 and the decisions referred to above, the omission, if any, on the part of a student in obtaining Eligibility Certificate shall not be an impediment for claiming registration, if he/she was entitled to Eligibility Certificate, had he/she applied for the same. In the light of Act 34 of 2001 and the decisions referred to above, the omission, if any, on the part of a student in obtaining Eligibility Certificate shall not be an impediment for claiming registration, if he/she was entitled to Eligibility Certificate, had he/she applied for the same. As noted, the specific case of the first respondent is that Avalon School of Medicine was not a recognised medical institution at the time when the petitioner joined for the medical course and therefore the petitioner was not entitled to the benefit of suspension. Insofar as the Eligibility Certificate is not institution specific and insofar as the first respondent has no case that dehors the institution in which the petitioner has undertaken the medical course, the petitioner was not entitled to the Eligibility Certificate, the omission on the part of the petitioner in not obtaining the Eligibility Certificate, that too, during the period in which the requirement under Section 13(4B) was under suspension, cannot be a ground disentitling the petitioner from claiming registration with the first respondent. The objection raised by the first respondent in the light of the decision taken by the Medical Council of India on 17.09.2012 in considering Ext.P10 application is therefore liable to be rejected on that ground as well. 17. That apart, the materials on record indicate that the decision dated 17.09.2012 was taken by the Medical Council of India on account of a doubt entertained by them as to whether the medical qualification granted by the Avalon School of Medicine is one recognised by Curacao and the decision was revoked later on being satisfied that the medical qualification of the said medical institution has been recognised by the said country. Ext.P12 communication issued by the Embassy of India in Caracas to the Ministry of Health and Family Welfare shows that the medical qualification granted by the Avalon School of Medicine was recognised by Curacao since August, 2011. Ext.12 communication is not one disputed by the first respondent. If that be so, the case of the petitioner that the decision of the Medical Council of India dated 17.09.2012 was a decision rendered by mistake is correct and the petitioner cannot be a victim of the said mistake. 18. Ext.12 communication is not one disputed by the first respondent. If that be so, the case of the petitioner that the decision of the Medical Council of India dated 17.09.2012 was a decision rendered by mistake is correct and the petitioner cannot be a victim of the said mistake. 18. The last ground on which the application of the petitioner for permanent registration was rejected by the first respondent is that the petitioner is not entitled to practice medicine in the country of education namely, Curacao. True, in terms of sub-section 4A of Section 13 of the IMC Act only persons who obtain medical qualifications granted by medical institutions abroad recognised for enrolment as medical practitioner in the country of education are entitled to be enrolled on any State Medical Register as a medical practitioner. The pleadings of the petitioner would show that the medical qualification obtained by her is recognized for enrolment as medical practitioner in the country of education once the candidate clears the USMLE also; that she has cleared USMLE after obtaining the medical qualification and that therefore she is entitled to practice in the country of education. It is seen that on the application preferred by the petitioner for permanent registration, the first respondent wrote a letter to the Consulate of India in Curacao to confirm whether the medical qualification of the petitioner is recognised for enrolment as a medical practitioner in that country. Ext.P15 is the communication issued by the first respondent in this regard. In response to Ext.P15, the Attache in the Embassy of India in Caracas has obtained a confirmation from the Avalon School of Medicine and forwarded the same to the first respondent. Ext.P16 is the communication received by the first respondent in this regard from the Embassy of India in Caracas. The letter of confirmation forwarded along with Ext.P15 indicates that the Avalon School of Medicine has confirmed that the petitioner is eligible to practice medicine in Curacao on the strength of the medical qualification obtained from the Avalon School of Medicine. It is seen that after Ext.P16 communication, the first respondent has addressed a letter straight to the Dean of the Avalon School of Medicine also requesting him to confirm whether the medical qualification obtained by the petitioner is recognised for enrolment as medical practitioner in that country. It is seen that after Ext.P16 communication, the first respondent has addressed a letter straight to the Dean of the Avalon School of Medicine also requesting him to confirm whether the medical qualification obtained by the petitioner is recognised for enrolment as medical practitioner in that country. Ext.P17 is the letter addressed by the first respondent to the Dean of the Avalon School of Medicine in this regard. Ext.P18 is the reply sent by the Avalon School of Medicine to Ext.P17 letter. In Ext.P18 letter also, the Avalon School of Medicine has affirmed that the medical qualification obtained by the petitioner is recognised to practice not only in that country but also in other countries like United States of America, Canada, etc. It is seen that along with the letters addressed to the Attache in the Embassy of India in Caracas and the Dean of Avalon School of Medicine, the first respondent has forwarded the documents submitted by the petitioner along with the application for registration and it is having regard to the fact that the petitioner has cleared the USMLE, Exts.P16 and P18 communications have been issued in response to the same by the addressees concerned. In the light of Exts.P16 and P18 communications, according to me, the aforesaid objection of the first respondent is also unsustainable. In the result, the writ petition is allowed. Ext.P20 order is quashed and the first respondent is directed to grant permanent registration sought by the petitioner in terms of Ext.P10 application. This shall be done within four weeks from the date of receipt of a copy of this judgment.