# Om Rathod v. The Director General of Health Services & Ors

- **Citation:** 2024 INSC 836
- **Court:** Supreme Court of India
- **Decided:** 2024-10-25
- **Case number:** Civil Appeal No. 12110 of 2024
- **Bench:** Dr Dhananjaya Y Chandrachud
- **Source:** https://unisonlegal.in/judgment/supreme-court-of-india/om-rathod-v-the-director-general-of-health-services-ors-37345
- **Pages:** 40

## Headnote

Appellant had lower limb myopathy, a locomotor disability. He secured
an all India PwD rank of 84 and a State PwD rank of 4 in NEET UG
Examination 2024. However, was held ineligible to pursue MBBS
course by the designated Medical Board at AIIMS, Nagpur holding
that the appellant was 88% disabled which was higher than the
maximum permissible disability fixed by the regulation governing
admission in the PWD category for MBBS course. By way of the
impugned judgment, High Court held that the certification of the
degree of disability was in accordance with prescribed procedures.
Headnotes†
Education/Educational Courses - MBBS course - NEET UG
Examination 2024 - Rights of Persons with Disabilities Act,
2016 - As per the Guidelines for admission of students with
'Specified Disabilities' under the 2016 Act w.r.t admission
in MBBS Course, persons having over 80% locomotor
disabilities may be admitted to a medical course on a case
to case basis after assessing their functional competence
to navigate academic and practical requirements - Vide
NEET Disability Certificate dtd. 13.08.24, Medical board at
AIIMS, Nagpur assessed the appellant's disability to be 88%
and therefore, held the appellant ineligible to pursue MBBS
course - Writ petition filed by appellant, dismissed by High
Court - Challenged - Supreme Court directed re-assessment
of the appellant by Medical Board at AIIMS, Delhi which
concurred with the AIIMS Nagpur Medical Board - However,
the Board noted lack of clear guidelines to assess disability
with assistive devices in terms of the guidelines - Direction
for re-assessment of the appellant for a functional competency
test - Appellant was assessed to be eligible for pursuing the
*Author
2188
[2024] 10 S.C.R.
Digital Supreme Court Reports
MBBS course with assistive devices - Permitted to participate
in the ongoing counselling - Appellant sought seat at the
college allocated in the initial rounds of counselling or at any
college in his home State-Maharashtra:
Held: Appellant was subjected to protracted and mentally exhausting
assessments that failed to apply the correct standards, leading to
a declaration of ineligibility - Report dtd. 13.08.24 of the Disability
Assessment Board of AIIMS, Nagpur quashed as it did not apply
the statutory and regulatory standards applicable to the assessment
of a person with disability- Impugned judgment of High Court set
aside - A supernumerary seat be created at the AIIMS, Nagpur and
allocated to the appellant if he has not already secured a seat at a
college of his choosing - College be given the report dtd.20.10.24
which makes suggestions as to the accommodations which may be
extended to the appellant - Judgement to apply in rem. [Paras 32, 59]
Directions by Supreme Court - Admission to persons with
disabilities into medical courses - Formulation of guidelines -
Inclusion of persons with disability in the medical profession -
Constitution of India - Preamble; Articles 21, 19, 14, 15 -
Preambular virtue of fraternity; Right to life, dignity, freedom,
equality and non-discrimination:
Held: National Medical Council to issue fresh guidelines for admitting
persons with disabilities into medical courses - The committee
formulating the guidelines must include experts with disability or
persons who have worked on disability justice - The guidelines
shall comply with the judgments of this Court and contemporary
advancements in disability justice - The Disability Assessment
Boards shall eschew from a benchmark model to test the functional
competence of medical aspirants with disability - The second
respondent shall issue appropriate guidelines in this regard - The
Disability Assessment Boards shall include a doctor or health
professional with disability as per the directions of the first respondent
dated 24 March 2022 - Conduct of the Disability Assessment
Boards shall be fair, transparent and in compliance with principles
of the rule of law - Attention must be paid to ensure that candidates
appearin

## Text

_Characters 0–39,951 of 89,930. This is a partial read: ask again with offset=39951 for what follows._

[2024] 10 S.C.R. 2187 : 2024 INSC 836
Om Rathod
v.
The Director General of Health Services & Ors.
(Civil Appeal No. 12110 of 2024)
25 October 2024
[Dr Dhananjaya Y Chandrachud,* CJI,
J.B. Pardiwala and Manoj Misra, JJ.]
Issue for Consideration
Appellant had lower limb myopathy, a locomotor disability. He secured
an all India PwD rank of 84 and a State PwD rank of 4 in NEET UG
Examination 2024. However, was held ineligible to pursue MBBS
course by the designated Medical Board at AIIMS, Nagpur holding
that the appellant was 88% disabled which was higher than the
maximum permissible disability fixed by the regulation governing
admission in the PWD category for MBBS course. By way of the
impugned judgment, High Court held that the certification of the
degree of disability was in accordance with prescribed procedures.
Headnotes†
Education/Educational Courses - MBBS course - NEET UG
Examination 2024 - Rights of Persons with Disabilities Act,
2016 - As per the Guidelines for admission of students with
'Specified Disabilities' under the 2016 Act w.r.t admission
in MBBS Course, persons having over 80% locomotor
disabilities may be admitted to a medical course on a case
to case basis after assessing their functional competence
to navigate academic and practical requirements - Vide
NEET Disability Certificate dtd. 13.08.24, Medical board at
AIIMS, Nagpur assessed the appellant's disability to be 88%
and therefore, held the appellant ineligible to pursue MBBS
course - Writ petition filed by appellant, dismissed by High
Court - Challenged - Supreme Court directed re-assessment
of the appellant by Medical Board at AIIMS, Delhi which
concurred with the AIIMS Nagpur Medical Board - However,
the Board noted lack of clear guidelines to assess disability
with assistive devices in terms of the guidelines - Direction
for re-assessment of the appellant for a functional competency
test - Appellant was assessed to be eligible for pursuing the
*Author
2188
[2024] 10 S.C.R.
Digital Supreme Court Reports
MBBS course with assistive devices - Permitted to participate
in the ongoing counselling - Appellant sought seat at the
college allocated in the initial rounds of counselling or at any
college in his home State-Maharashtra:
Held: Appellant was subjected to protracted and mentally exhausting
assessments that failed to apply the correct standards, leading to
a declaration of ineligibility - Report dtd. 13.08.24 of the Disability
Assessment Board of AIIMS, Nagpur quashed as it did not apply
the statutory and regulatory standards applicable to the assessment
of a person with disability- Impugned judgment of High Court set
aside - A supernumerary seat be created at the AIIMS, Nagpur and
allocated to the appellant if he has not already secured a seat at a
college of his choosing - College be given the report dtd.20.10.24
which makes suggestions as to the accommodations which may be
extended to the appellant - Judgement to apply in rem. [Paras 32, 59]
Directions by Supreme Court - Admission to persons with
disabilities into medical courses - Formulation of guidelines -
Inclusion of persons with disability in the medical profession -
Constitution of India - Preamble; Articles 21, 19, 14, 15 -
Preambular virtue of fraternity; Right to life, dignity, freedom,
equality and non-discrimination:
Held: National Medical Council to issue fresh guidelines for admitting
persons with disabilities into medical courses - The committee
formulating the guidelines must include experts with disability or
persons who have worked on disability justice - The guidelines
shall comply with the judgments of this Court and contemporary
advancements in disability justice - The Disability Assessment
Boards shall eschew from a benchmark model to test the functional
competence of medical aspirants with disability - The second
respondent shall issue appropriate guidelines in this regard - The
Disability Assessment Boards shall include a doctor or health
professional with disability as per the directions of the first respondent
dated 24 March 2022 - Conduct of the Disability Assessment
Boards shall be fair, transparent and in compliance with principles
of the rule of law - Attention must be paid to ensure that candidates
appearing before the Board do not feel uncomfortable on account
of physical or attitudinal barriers - Reasonable accommodation is
a gateway right to avail all other fundamental, human and legal
rights for persons with disabilities - Non-availability of reasonable
accommodation amounts to discrimination and violates substantive
equality of persons with disabilities - The inclusion of persons with
disability in the medical profession would enhance the quality of
[2024] 10 S.C.R.
2189
Om Rathod v. The Director General of Health Services & Ors.
healthcare and meet the preambular virtue of fraternity and the
guarantees in Articles 21, 19, 14 and 15 of the Constitution -
Applicants to the NEET examination must be informed about the
compliance of accessibility norms and provisions of reasonable
accommodation available at colleges - The respondents shall issue
appropriate directions to create a database with relevant information
on accessibility and reasonable accommodation - Enabling Units
at medical colleges shall act as points of contact for persons with
disability desirous of accessing clinical accommodations. [Para 60]
Rights of Persons with Disabilities Act, 2016 - Shift from
charity based to a rights based approach - Scheme of the
Act - Discussed - Appendix "H-1" of the Guidelines regarding
admission of students with 'Specified Disabilities' under the
Rights of Persons with Disabilities Act, 2016 with respect to
admission in MBBS Course - Purposive interpretation of -
Fair assessment of competence - Principle of reasonable
accommodation - Functional competency test - Purpose
stated - Constitution of India - Articles 21, 19, 14, 15 - Right
to life, dignity, freedom, equality and non-discrimination.
Disability Assessment Boards - Role; approach - Stated.
Case Law Cited
Omkar Ramchandra Gond v. Union of India, 2024 SCC OnLine
SC 2860; Nipun Malhotra v. Sony Pictures [2024] 7 SCR 246 :
2024 INSC 465; Ravinder Kumar Dhariwal v. Union of India [2021]
13 SCR 823 : (2023) 2 SCC 209; Vikash Kumar v. UPSC [2021]
12 SCR 311 : (2021) 5 SCC 370; Avni Prakash v. NTA [2021]
11 SCR 891 : (2023) 2 SCC 286; A (Mother of X) v. State of
Maharashtra [2024] 5 SCR 470 : 2024 INSC 371; Bambhaniya
Sagar Vashrambhai v. Union of India WP (C) 856 of 2023; Purswani
Ashutosh v. Union of India (2019) 14 SCC 422; Omkar Gond v.
Union of India (2024) SCC OnLine SC 2401; Vidhi Himmat
Katariya v. Union of India [2019] 12 SCR 821 : (2019) 10 SCC
20; Indra Sawhney v. Union of India [1992] Supp. 2 SCR 454 :
(1992) Supp. 3 SCC 217; Prathvi Raj Chauhan v. Union of India
[2020] 2 SCR 727 : (2020) 4 SCC 727 - referred to.
Books and Periodicals Cited
Judith Heumann & Kristen Joiner (2020). Being Heumann: An
Unrepentant Memoir of a Disability Rights Activist. Beacon Press :
Boston, Massachusetts; Singh S, Medical Council of India's new
2190
[2024] 10 S.C.R.
Digital Supreme Court Reports
guidelines on admission of persons with specified disabilities: Unfair,
discriminatory and unlawful. Indian J Med Ethics. 2019 Jan-Mar;
4(1) NS: 29-34. DOI: 10.20529/IJME.2018.064; UN. Committee
on the Rights of Persons with Disabilities (22nd sess). CRPD/C/
IND/CO/1. Concluding observations on the initial report of India :
Committee on the Rights of Persons with Disabilities. Geneva :
UN, 29 Oct. 2019 - referred to.
List of Acts
Rights of Persons with Disabilities Act, 2016.
List of Keywords
MBBS course; NEET UG Examination 2024; Medical aspirant;
Disability; Locomotor disability; Muscular Dystrophy; PwD category;
Persons with Disability; National Medical Council; Medical Board
at AIIMS; AIIMS, Nagpur; AIIMS, Delhi; Disability assessments;
Maximum permissible disability; Guidelines for admission of
students with 'Specified Disabilities'; Functional competence to
navigate academic and practical requirements; NEET Disability
Certificate; Assistive devices; Ongoing counselling; Disability
Assessment Board; Doctor or health professional with disability;
Functional competency test; Functional disability; Quantified
disability; Functional assessment; Disability law in India; Shift
from charity based to a rights based approach; Reasonable
accommodation; Fundamental rights; Preamble; Justice, liberty
and equality, fraternity; Disability rights; Convention on Rights of
Persons with Disability; Eradication of discrimination; Transparency,
fairness and consistency; Supernumerary seat; Inaccessibility;
Non-inclusion.
Case Arising From
CIVIL APPELLATE JURISDICTION: Civil Appeal No. 12110 of 2024
From the Judgment and Order dated 03.09.2024 of the High Court
of Judicature at Bombay at Nagpur in WPC No. 4918 of 2024
Appearances for Parties
Shadan Farasat, Sr. Adv., Talha Abdul Rahman, M Shaz Khan,
Taha Bin Tasneem, Sudhanshu Tewari, Rafid Akhter, Faizan Ahmad,
Prannv Dhawan, Advs. for the Appellant.
[2024] 10 S.C.R.
2191
Om Rathod v. The Director General of Health Services & Ors.
Ms. Archana Pathak Dave, A.S.G., Gaurav Sharma, Sr. Adv.,
Shashank Bajpai, Ms. Sushma Verma, Karunesh Kumar Shukla,
Gopi Chand, Amrish Kumar, Prateek Bhatia, Dhawal Mohan,
Paranjay Tripathi, Rajesh Raj, Ms. Ankita Dogra, Advs. for the
Respondents.
Judgment / Order of the Supreme Court
Judgment
Dr Dhananjaya Y Chandrachud, CJI
Table of Contents*
A.
Background........................................................................
3
B.
Pillar to post: scaling the ramparts of courts and
hospitals..............................................................................
5
C.
The maze to inclusion: RPWD Act and guidelines............... 15
D.
Principle of fair assessment of competence: reasonable
accommodation and the functional competence
model................................................................................... 19
E.
Building bridges for the nation: principle to practice......... 31
F.
Conclusions........................................................................ 42
The Stage
We didn't go up to the stage
no one asked us, actually
only by pointing fingers
they showed us our place
and we sat there;
'great', they exclaimed.
And they went up on the stage
started narrating us our own sorrows
but, 'our sorrows remained ours
never became theirs...'
- Waharu Sonavane1
* Ed. Note: Pagination as per the original Judgment.
2192
[2024] 10 S.C.R.
Digital Supreme Court Reports
A.
Background
1.
Legal principles and their application often stand at opposite banks
of the river. The distance between them is manifest before us. The
appellant has undergone a crash course in navigating the Indian
legal system - from statutory prescriptions, regulatory stipulations,
High Court adjudication, regulatory and court ordered disability
assessments to the race to justice before this Court. Four assessments
later - the appellant's fate now hangs in the balance and this
Court is asked to interfere to ensure that the balance does not tilt
unfavourably and fall into disarray. Vital foundational questions have
been thrown open for debate before this Court. What is expected of
an Indian medical graduate? Can a person with disability aspire to
meet these expectations? Or is their only option to resign their fate
to a society that places a premium on disabled bodies - every step
of the way? Academic and practical rigour of the medical profession
notwithstanding, should the journey of an Indian to navigate their
way into the medical profession be this arduous? Is our collective
obsession with disability too strong to focus on a person's ability?
Is our nation ready to benefit from the talent and experiences of
persons with disabilities? Or should we continue to sacrifice them
at the altar of technicalities?
2.
We answer these questions by rooting them in the web of
Constitutional law principles, statute, regulatory framework and
guidelines which are germane for this case. The bone of contention
before us turns on the manner in which the Disability Assessment
Boards must function while certifying the eligibility of a candidate
for the MBBS course. The appellant has lower limb myopathy -
a locomotor disability. The appellant has been an academic
success. He secured an A1 grade in his matriculate (Class X) and
intermediary (Class XII) examination held by the Central Board
of Secondary Education. He aspires, now, to enter the medical
profession. With this resolve, the appellant appeared for the NEET
UG Examination 2024 on 5 May 2024 under the unreserved/
EWS-PwD category and secured 601 marks (out of a total marks
of 720). This placed the appellant at an all India PwD rank of 84
and a State PwD rank of 4. Despite having a Disability Certificate
1
Poem translated from its original version in Marathi - written in the context of the tribal movement being
co-opted by persons who claim to speak on their behalf while simultaneously othering them.
[2024] 10 S.C.R.
2193
Om Rathod v. The Director General of Health Services & Ors.
dated 24 January 2021 which was to be valid until 2025 - the
appellant submitted himself to the mandatory assessment to get
his eligibility certified by a designated medical board at AIIMS,
Nagpur. Appendix "H-1" of the Guidelines regarding admission of
students with 'Specified Disabilities' under the Rights of Persons
with Disabilities Act, 2016 with respect to admission in MBBS Course
prescribes that persons having over eighty percent disability may
be admitted to a medical course on a case by case basis after
assessing their functional competence to navigate academic and
practical requirements.
3.
The medical board at AIIMS, Nagpur comprised of an Associate
Professor in Physical Medicine and Rehabilitation; an Assistant
Professor of Orthopaedics; and a Professor who was the Chairman
of the Disability Board at AIIMS, Nagpur. The Board, by a NEET
Disability Certificate dated 13 August 2024, opined that the appellant
is 88% disabled and is therefore ineligible to pursue an MBBS/
Dental course.
B.
Pillar to post: scaling the ramparts of courts and hospitals
4.
Aggrieved by this, the appellant filed a writ petition under Article 226
of the Constitution before the Nagpur bench of the High Court of
Judicature at Bombay, challenging the NEET Disability Certificate
issued by AIIMS, Nagpur. The High Court by the impugned judgment
dated 3 September 2024 dismissed the writ petition and held that
the certification of the degree of disability was in accordance with
prescribed procedures. The appellant challenged the impugned
judgment by a petition for special leave before this Court under
Article 136 of the Constitution.
5.
On 3 October 2024, this Court directed the appellant to appear
before a medical board at AIIMS, Delhi to reassess him keeping in
mind the circular issued by the first respondent on 24 March 2022.
The circular inter alia made mandatory directions to include a doctor
or health professional with disability in every Disability Assessment
Board. The appellant accordingly reported to AIIMS, Delhi at 11 AM
on 5 October 2024. The five member board submitted its report
dated 9 October 2024 inter alia finding that there were no changes
in most disability components despite assistive devices. The report
also stated that there are no clear guidelines available to assess
the disability with assistive devices. The report states as follows:
2194
[2024] 10 S.C.R.
Digital Supreme Court Reports
"The candidate was re-assessed with the assistive device
(single hand crutch & motorised scooty). There was minimal
to no change in most of the components for disability
evaluation as per the GOI gazette (March 2024) with these
assistive devices. The possibility of wheelchair usage was
also explored which might be required for better efficiency
in ambulation component in near future. However, there
are no clear guidelines available to assess the disability
with assistive devices as per the Govt. of India gazette
guideline. Further it is to be noted that safety, efficiency
and agility of movements are needed to independently use
the devices and many times some manual support is also
required which may not be available to the candidate at
all times and may affect the safety of the candidate and
the patients during the skills based training provided in the
various setups in the labs and hospitals during the MBBS
course training. The Board after careful evaluations of
all possibilities concurs with the opinion of the previous
medical board held at AIIMS Nagpur dated 13.08.2024
that the disability is above 80% even with consideration of
assistive devices and also both upper limbs have significant
involvement and hence the candidate is ineligible to pursue
MBBS course."
6.
The appellant in his affidavit countering the AIIMS, Delhi report has
elucidated his experience. He submits that he was made to wait for
long hours on each date when he was asked to appear. He was not
given clear directions or information about the steps to follow in his
assessment. The first stage of the examination was conducted by
an able bodied doctor from the PMR department who was unduly
focused on the medical condition of the appellant. He underwent a
large number of tests including climbing stairs and power assessment.
When the appellant informed the Board that he used (i) a wheelchair,
(ii) crutches, and (iii) an electric scooter for mobility, he was asked
why he did not bring his wheelchair. To this, the appellant stated that
bringing a wheelchair was not logistically possible given that he had
travelled from his place of residence at Washim in Maharashtra to
Delhi by air, on short notice.
7.
The Board did not ask him any questions which would allow the
appellant to counter the basis for the Board's findings. He was
[2024] 10 S.C.R.
2195
Om Rathod v. The Director General of Health Services & Ors.
only asked (i) if he would be able to undertake his professional
duties and (ii) if he could conduct his daily activities. He responded
positively to both and stated that he had already completed his
secondary education with the same disability and had managed
to navigate adequately thus far. Eventually, the AIIMS, Delhi
report dated 9 October 2024 fell into the error of being a mere
benchmark evaluation report. The report adjudged the disability of
the appellant to be 80% - down from 88% which was reported by
AIIMS, Nagpur on 13 August 2024. While the AIIMS, Nagpur report
did not evaluate the appellant with assistive devices to assess his
functional ability, the AIIMS Delhi report did use these devices but
ultimately opined that there were no government guidelines on the
use of such devices.
8.
By an order dated 18 October 2024, this Court noted the statement
of AIIMS, Delhi on the lack of clear guidelines and observed that the
AIIMS report failed to evaluate the (i) extent of functional disability
of the appellant; and (ii) the extent to which the use of assistive
devices would have the potential to bring the functional disability
within the permissible limits in terms of the government notification.
9.
Relying on the judgment of this Court in Omkar Ramchandra Gond v.
Union of India,2 we requested Dr Satendra Singh of Infinity Ability to
assist the Court on whether notwithstanding the quantified disability,
the appellant can pursue the MBBS degree course. In arriving at
his evaluation, Dr Satendra Singh was requested to examine the
appellant and to have due regard to such assistive devises and
their potential to assist the appellant to fulfil the requirements of the
degree course in medicine.
10. The appellant made himself available at the University College of
Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi
at 10 AM on 19 October 2024. He was made to undergo functional
assessment and was asked to demonstrate his competence at the
Medical Simulation Centre at the Physiology and Pathology central
lab. Dr Satendra Singh gauged the accommodations necessary for
the appellant by interacting with him to understand his limitations
and barriers. Accordingly, the following premises were established
in assessing the appellant:
2
2024 SCC OnLine SC 2860.
2196
[2024] 10 S.C.R.
Digital Supreme Court Reports
"Disability: Limb Girdle Muscular Dystrophy (mobilityrelated physical disability)
Potential Functional limitations: Inability to stand for long
hours; difficulty in standing suddenly from sitting position
Potential Barriers to learning: Lack of accessible spaces
What is being assessed: Cognitive, psychomotor and
affective skills and ability to arrive at a diagnosis using
patient history and examination in line with NMC's five
roles of an Indian Medical Graduate in CBME
Appropriate and reasonable accommodation: Given
the tight space of clinical environments, smaller/compact
scooters are a good choice which Om is already using. This
will allow him to continue with the pace and demands of
a busy ward/OPD/OT independently and is much superior
than a manual wheelchair which is often dependent on
human assistance."
11. Dr Satendra Singh submitted his report on 20 October 2024.
This Court duly furnished the report to the second respondent,
National Medical Council, on 21 October 2024 to enable them to
formulate their response. The report by Dr Satendra Singh outlined
the functional disability of the appellant to be an inability to stand
independently which may prove limiting in clinical rotations in
surgical settings. The report suggested solutions to enable the
appellant in such cases. The report further suggested clinical
accommodations for the appellant to reduce the barriers he may
encounter. The report determined the accommodations necessary
for the appellant to be reasonable and in compliance with existing
norms. The report formulated four questions and answered them
as follows:
"a) Would the proposed accommodation result in a failure
to meet the NMC CBME's inherent requirements?
Not in my opinion
b)
Would the accommodation legitimately jeopardize
patient safety? Not in my opinion
c)
Would the proposed accommodation result in the
improper waiver of a core requirement of the CBME?
Not in my opinion
[2024] 10 S.C.R.
2197
Om Rathod v. The Director General of Health Services & Ors.
d)
Would the proposed accommodation pose an undue
hardship on the medical college (budgets wise)? Not
in my opinion"
12. In stark contrast to the approach of the two AIIMS reports, when Dr
Satendra Singh assessed the appellant on the request of this Court,
he carried out a functional assessment. The process to determine
the clinical accommodation for the appellant involved having a
frank conversation with him about the barriers he faces - physical,
educational and attitudinal. The approach adopted was not whether
the appellant would succeed in a medical college but was rather
to ensure that the appellant has equal opportunity and can start at
the same level playing field as his classmates. After determining
the accommodations needed by the appellant through an interview
process, some questions were posed to him. These questions were
as follows:
"i.
How does muscular dystrophy impact you in daily life?
ii.
How have you mitigated this impact in an educational
setting (Class X,XII)?
iii.
What, if anything, exacerbates or worsens your
disability?
iv.
Do you anticipate needing to receive treatment such
that you may need to "step out" of the curriculum
at some point to attend to disability-related needs?
v.
Have you ever seen a clinical setting, or do you
anticipate additional barriers during the clinical
portion of your MBBS? (prompted with example
competencies)
vi.
Have you reviewed the MBBS curriculum? If not, we
can do this together to identify any potential barriers.
vii. Have you ever used assistive technology to mitigate
the impact of your disability?
viii. Are you aware of adaptive equipment used to navigate
the clinical environment.
ix.
What are your biggest concerns about entering the
MBBS program?
2198
[2024] 10 S.C.R.
Digital Supreme Court Reports
x.
What is your understanding of reasonable
accommodation which you repeatedly mentioned in
your affidavit."
13. Based on the preliminary conversation, the report noted that the
appellant is concerned about the differential treatment which was
meted out to him by previous Disability Assessment Boards despite
him having successfully navigated with the disability for his entire
life. The appellant was surprised that he was being doubted and his
accomplishments questioned without being afforded an opportunity
with simulation labs and reasonable accommodations.
14. The appellant was then made to undergo a functional assessment
which included being given various instruments which he would be
required to use in his course and profession. The nature of the tasks
given to the appellant shows that they were done in progression, with
basic instruments being given first, followed by the use of assistive
devices to examine his abilities and then being tested in other, more
complex tasks. The report states as follows:
"1.4 Functional assessment: Om was first shown how to
record blood pressure using a mercury sphygmomanometer,
how to elicit reflexes, and how to use a tuning fork to check
for deafness. He was then asked to demonstrate these
skills, which he successfully did, showing his eagerness
to learn after just one demonstration. Next, he was given
a foldable crutch to test whether it could assist him in
standing from a seated position, but I observed that he
has developed his own coping mechanisms to navigate
physical barriers. This is often an innovative strategy used
by people with disabilities in environments that are not
fully accessible.
He was then taken to the laboratory and asked to
reach examination tables of three different heights. He
was able to access two of them, demonstrating that an
adjustable examination table would be a suitable clinical
accommodation for him.
Afterward, he was taken to our Medical Simulation Centre,
where he was shown how to perform Cardiopulmonary
Resuscitation (CPR) in a simulated real-life scenario
[2024] 10 S.C.R.
2199
Om Rathod v. The Director General of Health Services & Ors.
of a person lying on the floor after a heart attack. After
the demonstration, Om sat down on the floor to perform
CPR. Considering it was his first experience in such
a lab (his previous two assessments did not involve
simulation), and to make the situation less intimidating,
he was first guided on a baby mannequin, which he
successfully managed. He also succeeded in giving an
intravenous and intramuscular deltoid injection, as well
as inserting a cannula after a demonstration. Please find
some pictures below.
For Om, who uses a mobility scooter, the functional
limitation lies in his inability to stand independently. This
may pose a challenge during clinical rotations in surgical
settings, where he would need to be at standing height to
observe procedures. Potential solutions could include using
a standing or hydraulic wheelchair, providing remote visual
access to the surgery via a monitor, or arranging for all
parties to sit during minor surgeries. These accommodations
can help mitigate barriers without imposing undue burden
The disability access appointee or Coordinator of the
Enabling Unit or Equal Opportunity Cell (as mandated
by the UGC) at Om's future medical college should
interact with him to propose these accommodations on
an individual basis before the preclinical, paraclinical, and
clinical rotations begin."
15. The report thereafter gave detailed (but not exhaustive) suggestions
for clinical accommodations for the appellant during his course - for
each of the years of his education and the mandatory internship. The
report finally outlined the overall assessment of the appellant and
declared him to be suitable, with appropriate clinical accommodations,
to pursue MBBS. The section of the report on overall assessment
reads as follows:
"4. Overall assessment
4.1 Throughout the assessment, Om's diagnosed muscular
dystrophy has not interfered with his learning or self-care.
He quickly adapted to new situations and found interesting
and unique ways to complete tasks in unfamiliar settings.
For example, while initially unfamiliar with the full extent of
2200
[2024] 10 S.C.R.
Digital Supreme Court Reports
the physical skills required in the MBBS program during the
simulation lab experience, Om expressed confidence that
these barriers could be easily mitigated using his existing
compensatory skills and creative approaches to procedures.
As an 18-year-old who flew on an airplane for the first
time while traveling for reassessment in Delhi, Om showed
remarkable zeal and passion for becoming a doctor and
is suitable with appropriate clinical accommodations
to pursue MBBS.
Om should be given opportunities to demonstrate how he
can successfully navigate clinical environments. Students
with disabilities should be "Welcomed and Valued," as
demonstrated by the General Medical Council UK's
guidelines on reasonable accommodation (GMC, UK). The
NMC should consider implementing similar regulations
to guide faculty and minimize attitudinal barriers rooted
in the medical model of disability. In the post-RPDA
(Rights of Persons with Disabilities Act) era, with the
advent of technology, we must welcome and recognize
the competence of students with disabilities.
4.2 Progressive Disability - Is It a Concern?
Such concerns fall into the realm of ableism. It is "a system
of assigning value to people's bodies and minds based
on societally constructed ideas of normalcy, productivity,
desirability, intelligence, excellence, and fitness. These
constructed ideas are deeply rooted in eugenics, antiBlackness, misogyny, colonialism, imperialism, and
capitalism. This systemic oppression that leads to people
and society determining people's value based on their
culture, age, language, appearance, religion, birth or living
place, "health/wellness", and/or their ability to satisfactorily
re/produce, "excel" and "behave." You do not have to be
disabled to experience ableism" (Lewis, 2022).
In Iyer Seetharaman Venugopalan vs. Union of
India, the Bombay High Court initially denied an MD in
Psychiatry to a blind doctor who had retinitis pigmentosa
and progressively lost his vision. However, thanks to the
intervention of the Supreme Court under Hon'ble CJI,
[2024] 10 S.C.R.
2201
Om Rathod v. The Director General of Health Services & Ors.
he was allowed to pursue Psychiatry and is now in his
final year, doing successfully. Similarly, Dr. Sharad Philip,
who also experienced progressive vision loss, successfully
completed his MD in Psychiatry from NIMHANS Bangalore
and is now a faculty member at AIIMS Guwahati.
Om can similarly choose to either remain a general
MBBS doctor or pursue a specialty that is less physically
demanding. Only he is best placed to take this decision
after completing MBBS. We should not restrict a bright
student on the basis of assumptions and ableist
beliefs."
16. Accordingly, the appellant was assessed to be eligible for pursuing
the MBBS course with assistive devices. The second respondent
has fairly accepted the eligibility of the appellant and has only joined
issue with the fact that the assessment of candidate by a doctor
must comply with the rules formulated under the statutory framework.
These rules require the assessing doctor to be a domain expert in
disabilities. In the present case this Court requested Dr Satendra
Singh to assess the appellant which shall not be a precedent. To
that extent the submission of the second respondent is accepted.
We may note that this Court was constrained to order a functional
competency test due to the failure of the previous two Boards to
apply the legally permissible standard. The appellant shall not be
made to undergo any further assessments as part of his admission
to the MBBS course. On 25 October 2024 this Court granted leave
and directed that the appellant be permitted to participate in the
ongoing counselling process arising out of NEET UG 2024.
17. Unfortunately, this run hardly obviates further labour. The appellant
finds himself re-entering the NEET counselling process after a lapse of
valuable time. He was allocated a seat at the Dr Shankarrao Chavan
Government Medical College, Nanded in the first and second rounds
of All India Level counselling. Now, stray vacancies for the category
of persons with disabilities at the All India Level are available in only
nine colleges, none of which are in the home State of the appellant -
Maharashtra. The appellant submits that none of the nine colleges
are compliant with accessibility norms and adequate support systems
necessary for him to enjoy a level playing field. The appellant now
prays that this Court create a seat for him at the college which he
was allocated in the initial rounds of counselling or for that matter at
2202
[2024] 10 S.C.R.
Digital Supreme Court Reports
any college in Maharashtra. The run of the appellant from Washim
to Nagpur and Delhi accompanied by several assessments now
stands the chance of being fruitless. The appellant prays that this
Court exercises its power to do complete justice under Article 142 of
the Constitution. Additionally, the appellant prays that this Court may
issue directives on the manner in which the grievances of exclusion
of disabled candidates is to be considered inter alia by courts.
C.
The maze to inclusion: RPWD Act and guidelines
18. Section 323 of the Rights of Persons with Disabilities Act 20164
stipulates that all Government and Government aided institutions of
higher learning shall reserve not less than five percent of seats for
persons with benchmark disability. The enactment of the RPWD Act
in 2016 marked a paradigm shift in disability law in India from charity
based to a rights based approach. Accordingly, the erstwhile Medical
Council of India5 formulated guidelines on admission of persons
with specific disability in MBBS courses. The Government of India
approved the proposal of the committee on 28 January 2019 and
issued a notification in the gazette on 5 February 2019.
19. The report stipulated the guidelines in Appendix "H" which laid down
six categories of locomotor disabilities including muscular dystrophy.
All persons with a locomotor disability above eighty percent were
rendered ineligible for medical courses. Appendix "H" was substituted
by Appendix "H-1" on 13 May 2019. The amendment allowed
persons with more than eighty percent locomotor disabilities to
pursue medical courses on a case to case basis. The new appendix
states as follows:
"Persons with more than 80% disability may also be allowed
on case to case basis and their functional competency
will be determined with the aid of assistive devices,
if it is being used, to see if it is brought below 80% and
3
"32. Reservation in higher educational institutions.-(1) All Government institutions of higher
education and other higher education institutions receiving aid from the Government shall reserve not
less than five per cent. seats for persons with benchmark disabilities.
(2) The persons with benchmark disabilities shall be given an upper age relaxation of five years for
admission in institutions of higher education."
4
"RPWD Act"
5
"MCI"
[2024] 10 S.C.R.
2203
Om Rathod v. The Director General of Health Services & Ors.
whether they possess sufficient motor ability as required
to pursue and complete the course satisfactorily."
(emphasis supplied)
20. The amended guidelines brought about a welcome change by
eschewing from a purely benchmark model to a functional ability
model. For candidates with more than eighty percent locomotor
disability, the guidelines allow their functional competency to be
determined using assistive devices to see if it can be brought below
80%. The second respondent has submitted that a new committee
will be constituted to recommend new guidelines for admission of
persons with disabilities into medical courses.
21. The report of the MCI (the erstwhile version of the second respondent)
which was the basis of the existing guidelines evidently found itself
working in the remnants of the pre-RPWD Act legal regime. Besides
making archaic observations requiring persons with disabilities to
'introspect and assess themselves whether they are likely to meet
MCI standards and outcomes' the guidelines also noted the definition
of reasonable accommodation in Section 2(y)6 of the RPWD Act. The
reference was only to further state that the standard of competence
cannot be lowered in the name of accommodation. The observations,
made without specific context on the standard or the accommodation
in question, states as follows:
"MCI is aware of this provision and respects it. However,
MCI cannot agree to enforce reasonable accommodation
that would alter or lower the standard of competence -
which exists to protect patients - that is required. Such
an accommodation, if granted would be 'unreasonable',
and not reasonable. Moreover, in some cases, even with
reasonable accommodation, it may not be possible for
every disabled medical student to successfully and safely
undertake all stages of medical education and training "
22. From promoting self-rejection of disabled medical aspirants to
assuming that their accommodations would lower the standard of
6
"(y) "reasonable accommodation" means necessary and appropriate modification and adjustments,
without imposing a disproportionate or undue burden in a particular case, to ensure to persons with
disabilities the enjoyment or exercise of rights equally with others;"
2204
[2024] 10 S.C.R.
Digital Supreme Court Reports
competence and would regardless be fruitless - the guidelines have
charted their way into disrepute. Vitally, the resistance to alter the
standard in a framework that has historically effaced a marginalised
group - namely disabled persons other than in the capacity of a
patient - is antithetical to any rights based approach to disability law.
Many other issues of critical importance arise from these guidelines
which are not germane to evaluate the case before us but may be
open for an appropriate proceeding.7 The current guidelines allow
persons with more than eight percent locomotor disability to be
admitted to MBBS course on a case by case basis after a functional
competency to see whether their disability can be 'brought below
80%.' Before proceeding to analyse this guideline, it is essential that
we clarify the phrase 'brought below 80%'.
23. The intention of the guideline in using the term 'brought below 80%'
is ostensibly to mean that the functional assessment shall evaluate
if the person with disability can perform the tasks which they are
expected to perform as a student and a practitioner. The assumption
in using the phrase 'below 80%' defeats the purpose of the guideline
which is to allow candidates into the MBBS course on a case by case
basis. Bodies are not biological parts put together - each to serve a
pre-determined role. They are alive - with thoughts, feelings, dreams
and aspirations. All bodies - abled and disabled - are guaranteed
dignity under the Constitution. A person with disability has to navigate
the rigours of a society which was modelled on the premise of their
absence. The disability of a person is a reflection on the inaccessibility
of the society and not a comment upon the individual. A person does
not overcome disability but learns to navigate life with it. Disability
is not a thing to be overcome or brought down, but an attribute to
be acknowledged and accommodated. The use of the term 'brought
below 80%,' as well intentioned as it may be, fails at this foundational
premise. One cannot assume that all persons with more than 80%
locomotor disability are incompetent to pursue medicine when their
functional abilities have not been assessed.