For patient safety, legal clarity, and regulatory accountability, strict adherence to pre-registration requirements may be necessary
The integrity of the medical profession is based on the principles of ethical accountability and legislative oversight. While professional ethics bodies such as the Ethics and Disciplinary Committee of the Goa Medical Council (GMC) are responsible for upholding medical conduct, legislative instruments like the Goa Clinical Establishments (Registration and Regulation) Act, 2019 and its Amendment Bill, 2024 aim to ensure regulatory compliance within clinical establishments.
Contrastingly, an ethical conundrum arose on July 19, 2024 with respect to the Committee’s decision in Ethics and Disciplinary Case No: GMC/EDC/2024/01 before the Goa Medical Council concerning an unregistered medical practitioner and the conferment of retroactive registration by the Ethics and Registration Board while the State Government of Goa endeavours to effect the mandatory registration framework imposed by the Goa Clinical Establishments (Registration and Regulation) Amendment Bill, 2024.
On 19.07.2024, the Ethics and Disciplinary Committee of the Goa Medical Council rendered a decision that effectively regularised the unregistered medical practice of the medical practitioner who had been performing laparoscopic surgeries at a Hospital in South Goa in the capacity of a consultant surgeon. Essentially, this consultant surgeon was not registered with the Goa Medical Council and hence was not eligible to perform surgeries within the territorial jurisdiction of the State of Goa and consequently, any informed consent which was obtained by this unregistered surgeon would be invalid for lack of registration as a medical practitioner before the Medical Council.
The Committee, despite acknowledging that the medical practitioner had practised in Goa for 10 months without a valid registration, granted him retroactive registration — a decision that validated past unregistered practice instead of enforcing statutory penalties.
This decision happens to be at variance with fundamental principles of medical regulation. Under the National Medical Commission (NMC) Act, 2019, which prescribes that no medical practitioner may lawfully operate within Goa without first securing state registration. By granting retroactive registration, the Ethics Committee appeared to undermine its disciplinary role as well as public trust in regulatory institutions.
On 15.03.2024 , the Governor of Goa promulgated the Goa Clinical Establishments (Registration and Regulation) (Amendment) Ordinance, 2024 (Ordinance No. 4 of 2024) which was an Ordinance amending the Goa Clinical Establishments (Registration and Regulation) Act, 2019.
The present Amendment Bill, 2024, seeks to enforce strict compliance with registration requirements for all clinical establishments and their associated medical practitioners.
Key provisions of
Amendment Bill, 2024 (SUBHEADS)
1. Mandatory registration before commencement of practice – No clinical establishment or medical professional may operate in Goa without obtaining prior registration.
2. Enhanced penalties for non-compliance – The Amendment introduces stricter penalties for unregistered medical practice, including fines and closure orders against defaulting clinical establishments.
3. Increased government oversight – The Bill grants the State Government enhanced powers to monitor compliance and impose penalties on establishments or individuals operating without proper registration.
4. Repeal of the Goa Clinical Establishments (Registration and Regulation) (Amendment) Ordinance, 2024 (Ordinance No. 4 of 2024) – The Bill, once enacted, will replace the emergency measures implemented under the March 2024 Ordinance.
Ethical exemption vs
Legal compliance
The Ethics and Disciplinary Committee’s decision on July 19, 2024 in Case No: GMC/EDC/2024/01 to grant retroactive registration to a medical practitioner appears to be inconsistent with the objectives of the Goa Clinical Establishments (Registration and Regulation) (Amendment) Bill, 2024.
While the Bill, 2024 mandates registration as a prerequisite for medical practice , the Ethics Committee’s ruling resulted in the validation of an instance of medical practice that had been conducted in contravention of state registration laws.
This raises certain considerations: Regulatory ambiguity: If retroactive registration is permitted in one case, a precedent could be set wherein other practitioners may operate without registration, expecting ex post facto validation.
Undermining legislative mandates: If the State Government is actively working towards strict enforcement of registration requirements , regulatory bodies are expected to act in alignment with such legislative provisions rather than regularising past non-compliance.
Ensuring patient safety: Medical registration exists to ensure patient safety by verifying the credentials, qualifications, and competency of practitioners . Allowing medical practice in the absence of registration, even temporarily, may expose patients to unverified medical care.
The Ethics Committee’s decision highlights a potential gap between legislative and regulatory enforcement mechanisms. It would be advisable for the government of Goa to establish clearer guidelines on the intersection of professional disciplinary actions and statutory regulatory mandates.
Recommendations
for policy alignment
1. No exemptions for unregistered medical practice: The Goa Medical Council may consider aligning its disciplinary framework with the provisions of the Amendment Bill, 2024 , ensuring that no medical practitioner is allowed to practise without valid registration.
2. Stronger government oversight on medical disciplinary bodies: The State Government may consider issuing clarifications on whether regulatory authorities are empowered to validate past instances of unregistered practice.
3. Public transparency on medical licensing: Clinical establishments and medical professionals may be listed in a public registry accessible to patients , ensuring informed medical choices.
The Goa Clinical Establishments (Registration and Regulation) (Amendment) Bill, 2024, is therefore designed to enhance medical accountability. However, its implementation may be affected if statutory medical bodies, such as the Goa Medical Council, continue to allow retroactive registration. For patient safety, legal clarity, and regulatory accountability, strict adherence to pre-registration requirements may be necessary. The State Legislature and medical regulatory authorities could work together to ensure uniformity and consistency in medical registration policies within Goa.
