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Cuttack: While dismissing a petition filed by a Professor of Physiology seeking early retirement, the Orissa High Court recently highlighted a “troubling pattern” of doctors across the country seeking voluntary retirement in an “alarming number”.

Terming it a growing public health crisis, the HC bench comprising Justice S.K. Panigrahi held that if the situation continued, it would weaken the foundation of the healthcare system, leaving the patients without access to treatment.

“A troubling pattern has emerged as doctors across the country continue to seek voluntary retirement in alarming numbers. This is not merely an administrative inconvenience but a growing public health crisis. If left unaddressed, this unchecked exodus will weaken the very foundation of the healthcare system. It will leave the sick without healers, the suffering without aid, and the state unable to fulfil its most fundamental duty, which is the protection of life,” observed the bench.

In respect of the plea, the Court observed that the demands of individual preference must yield where the greater public good is at stake and accordingly, the bench directed the State Government to amend the provisions on voluntary retirement in the Odisha Civil Services (Pension) Rules, 1992.

“…the concerned Department shall amend the provisions on voluntary retirement in the OCS (Pension) Rules, 1992, aligning them with the evolving framework in other States. This reform shall be undertaken within three months from the date of this judgment,” ordered the Court. However, recognising that the law alone cannot help the situation, the Court also laid down some broad policy recommendations and asked the Government to consider the same to draft a framework for the retention of doctors within the healthcare system.

These observations were made by the High Court bench while considering a plea filed by a doctor, who challenged the order issued by the Commissioner/Secretary, Health and Family Welfare Department, rejecting her application for voluntary retirement on the grounds of “larger public interest” and citing a critical shortage of faculty in Government Medical Colleges.

Case Details: 

The petitioner is a Professor in Physiology at MKCG Medical College and Hospital, Berhampur. On 28.04.2024, she was transferred and appointed as the Superintendent at SRM Medical College and Hospital, Bhawanipatna, Kalahandi through a notification issued by the Health Department.

However, instead of joining at her new place of posting, the petitioner submitted a representation seeking cancellation of the transfer order, requesting instead to be accommodated as a Professor in Physiology at SJMCH, Puri.

On 06.03.2024, after her request for transfer cancellation was denied, she applied for leave on health grounds. Following this, a recall notice dated 20.06.2020 was issued, directing her to immediately join the SRM Medical College and Hospital, Bhawanipatna. On 24.06.2024, instead of complying with the recall order, the petitioner submitted an application for Voluntary Retirement (VR) from government service, citing her illness as the reason.

The VR Committee, constituted to review such requests, convened on 27.08.2024, and after due deliberation, rejected her application on 17.09.2024, stating that her retirement could not be permitted due to an acute shortage of doctors in government medical institutions across the state. Challenging this, the petitioner filed a plea before the High Court arguing that the decision to reject her VR application was arbitrary and illegal.

It was argued by the petitioner that as per Rule 42 of the Orissa Pension Rules, Voluntary retirement could not be denied if the application had completed the qualifying service period (more than 20 years) unless a disciplinary proceeding is pending or a major penalty has been imposed. Pointing out that no disciplinary proceeding or penalty existed against her, she argued that the rejection was illegal and against the rules.

She further asserted that the rejection order was issued without due consideration of her health condition and was merely a routine denial. She also claimed that the authorities failed to properly examine her medical conditions before rejecting the request. She further submitted that her progressive vision loss and cardiac issues made it impossible for her to continue working effectively and therefore, the denial of VRS on the pretext of faculty shortage was unjustified when compared to her individual right to health and well-being.

On the other hand, the Government authorities argued that under Rule 42(2) of the Pension Rules, the request for VR is subject to acceptance by the appointing authority. At this outset, reliance was placed on the order in the case of the State of Uttar Pradesh and Ors. v. Achal Singh, where the Court upheld the rejection of VR applications by doctors due to public interest considerations.

It was submitted that the VR Committee, after examining multiple applications for voluntary retirement, found that there was a severe shortage of medical faculty in government medical colleges and hospitals across Odisha. The National Medical Commission (NMC) has prescribed Minimum Standard Requirements (MSRs) regarding faculty strength, which the government is struggling to meet. Further, the medical education in the State is suffering due to a shortage of Faculty Members.

The State submitted that the acute shortage of doctors has already led to situations where new medical colleges, such as JK MCH, Jaipur, were permitted to operate with only 50 MBBS seats instead of 100 due to a lack of adequate teaching faculty and given these constraints, retaining experienced senior medical faculty was essential for the functioning of government medical institutes. Therefore, the rejection of the petitioner’s VR application was not arbitrary but a necessary administrative decision taken in the larger public interest.

Further, the State argued that the sequence of events suggested that the petitioner’s true reason for seeking VR was not health concerns but dissatisfaction with her transfer. The State highlighted that before her transfer, which she was serving at MKCG Medical College and Hospital, Berhampur, the petitioner never complained of any illness that prevented her from discharging her duties.

Court’s Observations: 

While considering the matter, the Court observed that the heart of the dispute lied in the petitioner’s refusal to comply with her transfer and her subsequent attempt to retire voluntarily, which was denied in the light of exigencies of public health and the pressing need for medical professionals in state service.

“The question before this Court is not a novel one. Courts have long been called upon to weigh the right of a doctor to step away from service against the broader demands of public health. Case after case has traced the same familiar fault line, the individual’s freedom to choose the course of their own life on one side, and the state’s interest in preserving the machinery of public care on the other. The law does not pretend that these interests will always align. It recognizes that there will be friction, moments when duty pulls in one direction and necessity in another. The task of this Court, then, is not to deny this conflict but to decide, in the given circumstances, which claims bears the greater weight. Does the State’s need for doctors justify holding a reluctant hand to the plow? Or does justice demand that, after years of service, an individual be allowed to step away, unshackled by burdens they can no longer bear?” observed the Court.

Relying on legal precedence set by the Supreme Court and Calcutta HC, the Orissa HC bench observed,

“A review of the foregoing precedents leaves no room for doubt that the demands of public health and the imperatives of societal welfare require the maintenance of a stable and sufficient body of physicians in service to the state.”

“The physician, like the judge, holds a station not for herself alone but for the common good. When one doctor retires, it is not merely an individual decision; it is a fissure in the foundation upon which the health of the people rests. If one follows, and then another, unchecked by the necessity of reasoned regulation, the state is left not with a functioning system of care but with a hollow structure, unfit to bear the weight of the public’s need. The law, in its wisdom, does not permit a doctrine of absolute individualism where the withdrawal of service, en masse or in isolation, leaves the vulnerable without aid,” it further noted.

The bench observed that across States, Uttar Pradesh, West Bengal, Tamil Nadu, and others, the Government have codified the power to reject voluntary retirement when the withdrawal of service threatened the well-being of the public. “It is within these rules that the balance was struck, where the scales tipped toward the State and, by extension, toward the people it serves,” it noted.

At this outset, the Court observed that in Odisha, the OCS (Pension) Rules, 1992 remained silent where they ought to speak. “They lack the safeguard that other states have rightly recognized, that a profession whose absence imperils life itself cannot be surrendered at will. The law, in its present form, leaves an opening, a path unguarded, through which a public servant, however essential his role, may exit without restraint. But the absence of a rule does not negate the presence of a duty. A physician is no mere functionary; she is an agent of public trust, a steward of life itself,” it held.

Personal Interest Yields to Greater Public Good: 

The Court highlighted that a doctor, upon taking the Hippocratic Oath, does more than embrace the science of healing; she assumes a higher duty to society, one that does not bend to convenience or withdraw at will.

“To wear the mantle of a lifesaver is to accept that personal interest must, at times, yield to the greater public need,” it observed.

“A doctor, trained at the expense of the State, has been the beneficiary of a system that, without immediate recompense, has invested in her skill and knowledge for the greater good of society. It is not the individual alone who bears the burden of her education; it is the public that has furnished the means, the resources, and the opportunity. To allow her, once fashioned into a vessel of healing, to cast aside her obligations in pursuit of greener pastures, heedless of the need that bred her, would be to permit a kind of opportunism that the law cannot abide. The duty owed is not one of compulsion but of conscience, not of servitude but of service. If the community has laboured to create the healer, the healer must not, when the moment of her usefulness is at hand, turn away from the very hands that uplifted him,” the Court further noted.

However, the Court underlined that the sense of duty is not absolute and the obligations of a public servant must be anchored in clear rules and governed by certainty, not left to the shifting landscape of personal interpretation.

Doctors Seeking VRS in Alarming Numbers: 

Observing that doctors in alarming numbers are opting for VRS across the country, the Court observed that this would leave the healthcare system fragile. However, it also observed that law alone cannot stem the tide. 

“…legislation, without more, is no cure; it is a patch upon a fracture too deep to be mended by restraint alone. The true remedy lies not merely in restricting departure, but in removing the very reasons doctors seek to leave. To prevent doctors from leaving, we must give them reason to stay,” observed the Court. 

It held that if the doctors find themselves compelled to retire over matters as routine as transfers, then it is not the law alone that has failed them, but it is the very system meant to support them.

“Strengthening healthcare infrastructure, improving working conditions, and ensuring that those entrusted with healing others are not themselves burdened by inefficiency and neglect, these are not secondary considerations. They are the very heart of the solution. A law that restrains without reform is not protection but mere postponement. The state must not merely command service but make service itself worthy of commitment,” it observed, adding that where the legislature has not spoken, the duty falls upon the courts to lay down the gavel with certainty, to step into the breach, and to ensure that justice does not falter for want of command.

Court lays down recommendations to ensure retention of doctors: 

The court recognized the indispensable role of physicians in safeguarding public health and also the “growing crisis of attrition” among medical professionals. 

With this observation, the Court, in the exercise of its constitutional duty to uphold the right to healthcare, issued the following broad policy recommendations for the Government’s consideration in drafting a framework for the retention of doctors within the healthcare system:

“a) The government shall ensure that compensation structures for physicians are reformed in a manner that is equitable, transparent, and commensurate with their professional contribution. Remuneration must be aligned with evolving healthcare priorities, ensuring that the pursuit of financial sustainability by health systems does not result in unjust diminution of physicians’ wages.

b) The State shall undertake necessary measures to integrate worklife balance principles into the healthcare profession, ensuring that the physical and mental well-being of physicians is preserved. Rigid clinical schedules that undermine a physician’s right to family life and personal wellness shall be subject to revision in favour of flexible and sustainable working conditions.

c) Physicians, being central to the provision of healthcare, must be accorded a substantive role in the decision-making processes that govern clinical operations, resource allocation, and policy formulation.

d) Healthcare institutions must be mandated to adopt robust and effective staffing models that ensure sufficient support personnel, so that physicians are neither overburdened with administrative tasks nor unduly encumbered with duties that can be competently performed by allied healthcare professionals.

e) The government shall prioritize investment in technological interventions that ease the administrative and documentary burdens imposed upon physicians. Any introduction of digital systems or artificial intelligence tools must be carried out in consultation with medical professionals.

f) The government shall initiate and oversee the establishment of mental health and wellness programs specifically tailored to address physician burnout. A culture that stigmatizes help-seeking behaviors among medical professionals shall be actively dismantled, and systems of peer support, counselling, and psychological care shall be integrated within healthcare institutions.

g) Given the critical nature of physician retention, the government shall direct healthcare systems to undertake periodic internal reviews, including structured feedback mechanisms, to assess and address concerns raised by medical professionals regarding workplace conditions, compensation, and administrative inefficiencies.”

“It is expected that the government shall act upon these recommendations with the urgency and gravity that the present crisis demands. The retention of physicians within the healthcare system is not merely a matter of administrative efficiency or economic pragmatism but a question of ensuring the continuity of essential services that sustains the very framework of public health,” it held.

Accordingly, the Court dismissed the plea, finding no merits in it. It highlighted that the scarcity of doctors is not a mere inconvenience but a matter of grave public concern and therefore, allowing the petitioner to retire would set a precedent that would risk unravelling the very fabric of healthcare system. “The demands of individual preference must yield where the greater public good is at stake,” reiterated the Court.

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/orissa-hc-vrs-276633.pdf

Also Read: HC Denies Compensation to MBBS Aspirant Who Claimed Losing GMC Seat Due to Technical Glitches

Ahmedabad: Zydus, a discovery-based, global pharmaceutical company is ready to launch the season’s first India’s Flu protection as per WHO recommended composition of quadrivalent influenza virus vaccines for use in the 2025 southern hemisphere.

The company’s Quadrivalent Inactivated Influenza vaccine VaxiFlu-4 will offer protection against A/Victoria/4897/2022 (H1N1)pdm09-like virus, A/Croatia/10136RV/2023 (H3N2)-like virus, B/Austria/1359417/2021 (B/Victoria lineage)-like virus, B/Phuket/3073/2013 (B/Yamagata lineage)-like virus. A quadrivalent vaccine, by covering strains of both influenza A and influenza B, provides a broader protection and significantly reduces the risk of vaccine mismatch. The vaccine has been cleared by the Central Drug Laboratory (CDL).

VaxiFlu-4 is being marketed by Zydus Vaxxicare-a division of the group focussing on preventives. The Quadrivalent Inactivated Influenza vaccine has been developed at the Vaccine Technology Centre (VTC) in Ahmedabad which has proven capabilities in researching, developing, and manufacturing of safe and efficacious vaccines.

Speaking on the development Dr. Sharvil Patel, Managing Director, Zydus Lifesciences Limited said, “Preventives are the key to public health in both the developing and the developed world and vaccines have the potential to improve the quality of life. In India, there is a pressing need for access to affordable, high-quality vaccines that can address healthcare challenges. With vaccines like VaxiFlu-4 we are serving the cause of public health through annual immunisation and preventing flu outbreaks.”

Because of annual and occasional outbreaks, the control of influenza has become a major public health challenge. Annual Influenza (flu) vaccination is the best way to prevent flu and its potentially serious complications. Influenza is a contagious respiratory illness caused by influenza viruses which spreads from person to person, mainly through airborne respiratory droplets generated from coughing and sneezing or direct contact with an infected surface or individual. It can cause illnesses that range in severity and at times lead to hospitalization and death-with the latter occurring mainly in high-risk groups, such as under-five children, the elderly, and people with immunosuppressive and chronic medical conditions. According to the World Health Organization (WHO), seasonal influenza results in 290,000-650,000 deaths every year.

Mumbai: The former head of the Gynaecology and Obstetrics Department at Topiwala National Medical College and BYL Nair Charitable Hospital, the prime suspect in the 2019 postgraduate medico Dr Payel Tadvi suicide case, is set to be added as an accused in the case. A sessions court approved the prosecution’s plea on Friday.

The allegations against Dr Ching Ling Chiang, the former HoD, are grave, as she allegedly refused to assist the deceased medico and repeatedly ignored her complaints of ragging and harassment by three senior postgraduate students. Instead of reporting the abuse to the college management, Dr Chiang dismissed Tadvi’s concerns and advised her to endure the mistreatment. Her failure to take action is believed to have enabled the harassment that ultimately led to Tadvi’s suicide in May 2019.

Also read- PG Medico Suicide Case: Prosecution plea seeks to add former HoD Gynaecology as Accused

This latest development follows a recent plea by the prosecution in the Dr Payal Tadvi suicide case to include Dr Ching Ling Chiang as an accused. After reviewing the evidence and arguments, the special court, constituted under the Scheduled Caste and Scheduled Tribes (Prevention of Atrocities) Act, gave a nod to the prosecution’s request to frame charges against Dr Chiang.

The court’s decision to add Dr Chiang as an accused was based on Section 319 of the Criminal Procedure Code (CrPC), which allows courts to prosecute additional individuals if evidence suggests their involvement in a crime. Now, the court will proceed with the trial involving all the accused- the three seniors and Dr Chiang in the case.

Besides the court order, the anti-ragging committee of the medical college has recommended administrative action against Dr Chiang by supporting the prosecution plea. 

Medical Dialogues had extensively reported about the unfortunate case, wherein the 26-year-old PG medico Dr Payal Tadvi pursuing MD Gynecology from a well-known BYL Nair Hospital in Mumbai had allegedly committed suicide by hanging herself in her hostel room in May 2019. The doctor was allegedly under depression as three of her senior colleagues allegedly used to harass her with casteist remarks. 

A complaint was moved by the medico’s family, and a case against the trio was registered under section 306 (abetment for suicide) of the Indian Penal Code (IPC), sections of the SC/ST Atrocities Act, Anti-Ragging Act and Information Technology Act, 2000. Later, the Bombay High Court granted bail to these three doctors and directed the trio to submit a surety of Rs 2 Lakh. In 2020, the Supreme Court allowed this trio to go back to the college and hospital to pursue their postgraduate medical studies.

Medical Dialogues recently reported that five years after Dr Payel Tadvi’s tragic suicide, the prosecution moved to frame charges against the former head of the Department of Gynaecology and Obstetrics at Topiwala National Medical College & BYL Nair Charitable Hospital. In 2024, a special court in Mumbai decided to proceed with the trial against three women doctors accused of abetting the suicide of their junior colleague, Dr Payal Tadvi.

The court, on May 30, dismissed the discharge applications filed by the accused, who are currently out on bail and imposed a fine of Rs 25,000 on each of them for filing pleas that lacked merit. On November 13, special public prosecutor Pradip D. Gharat filed a plea before the court, arguing that Dr Ching should be called together with the other accused for framing charges. 

The prosecution’s plea highlighted several incidents that allegedly point to Dr Ching’s failure to intervene effectively. According to the plea, Tadvi’s mother, Abeda Salim Tadvi, and her niece, Asha Tadvi, approached Dr Chiang multiple times, informing her about the ongoing harassment Tadvi faced at the hands of her seniors. However, Dr Chiang allegedly dismissed their concerns, claiming that such incidents were common and did not warrant any special attention.

Payal Tadvi then informed her mother that the department head had called her and the three seniors to discuss the incident. The prosecution claimed that Dr Chiang failed to intervene appropriately and exacerbated the situation by siding with the accused seniors. The prosecution submitted that Dr Ching’s action, therefore, had encouraged and provoked the seniors, which facilitated the offence instead of preventing it. According to the prosecution, Dr Ching’s actions thus incited the seniors, which enabled rather than prevented the offence.

The charge sheet filed by the Mumbai Police presented strong evidence of the caste-based nature of the harassment Dr Tadvi faced. The documents included a suicide note in which Dr Tadvi had accused the three seniors of using casteist slurs against her. The charge sheet also includes testimony from witnesses who describe the verbal and physical bullying Dr Tadvi endured during her time at the college.

Witnesses corroborated these claims. The prosecution stated that five key witnesses in the case had confirmed the role of the accused in abetting Tadvi’s suicide. One of Dr. Tadvi’s colleagues testified that during a meeting with Dr. Ching, the three accused students were only given a verbal warning. Furthermore, Tadvi’s mother and husband had requested Dr. Chiang to transfer Tadvi to a different college unit, but the department head refused.

Welcoming the court’s move, Tadvi’s husband, Dr Salman Tadvi, told HT, “We repeatedly complained, but the HOD never acted. If she had intervened, this tragedy could have been avoided. Payal had also mentioned in her suicide note that she sought help from the HOD multiple times, but no action was taken. Just a week before the suicide, we had met Dr Chiang, who allegedly insisted that Payal must obey her seniors.”

Also read- Court denies relief to 3 doctors accused of abetting suicide of Dr Payal Tadvi in 2019

Uttar Pradesh- To improve access to healthcare services and promote medical education, the Uttar Pradesh government approved the establishment of new medical colleges in Baghpat and Kasganj districts of the states under its ‘One District, One Medical College’ (ODOM) initiative.