Category Archives: Medical College Bond

ESIC on the right path, now: Nurses lead! Let the Doctors follow!!

Medical Officers in the ESIC

1988

For more than six months, there was a flurry of activity in the medical administration division. A powerful lobby from inside and outside was working to amend the Recruitment Regulations to wean away from the UPSC the power of recruitment of medical officers in the ESIC, in spite of resistance to it from the Director General, Mrs. Kusum Prasad.

Although the ESIC was made an autonomous body, Sec. 17 of the ESI Act, 1948 mandated that all the Group ‘A’ and ‘B’ posts would be filled up only in consultation with the UPSC. But, the lobby that worked succeeded and the amendment to Sec. 17 (3) came, along with many others in 1989, excluding the medical posts in Group A and Group B, i.e., from the posts of IMO.Gr. II and above, from the purview of the UPSC.

In the year 1991, during her visit to Chennai,  the same Director General said that the experience proved that the amendment was wrong.

2002 and 2003.

About 300 posts of IMOs were required to be filled by Direct Recruitment. The political masters wished to have their way with the selection of IMO Gr. II. They did not want written test but only interview. But, it was resisted successfully by the two successive CEOs of the ESIC. The recruitment of about 300 IMOs got delayed to some extent because of the political interference. Selection was, ultimately, done by holding preliminary written screening test. This was an unnecessary problem those CEOs had to encounter, because of the unwarranted amendment made in 1989.

These problems would not have arisen, if only the UPSC had continued to recruit the medical officers as was in position upto 1989.

2009.

An amendment was made, in the year 2009, to Sec. 17 and the very sub-section 17(2)(a) was not made applicable to the “appointment of consultants and specialists in various fields appointed on contract basis”.

Sec 17

The terms, ‘consultants’, ‘specialists’ and ‘various fields’ were not defined anywhere in the amended Act.

The terms of contract were not codified and the central government model contracts in health sector could not be cited as models, because of the exclusion of Sec. 17(2)(a) in toto.

The approval for this amendment was obtained from the Parliament giving impression to the Members of Parliament that these consultants and specialists were required for better delivery of super speciality services. Para 4 (viii) of the ‘Statement of Objects and Reasons’ that accompanied the Bill for the said amendment said that the amendment was intended to enable the ESIC “to appoint consultants and specialists on contract without referring the matter to the central government for better delivery of super-speciality services”. The Members, therefore, believed that the requirement of the ESIC was for physicians and surgeons to provide medical treatment on super speciality and voted for the amendment, relying on the Statement of Objects and Reasons.

Bill Reasons

But, in the amendment, i.e., in the newly inserted proviso to Sec.17 (2) (a), the important phrase “super-speciality services” had, simply, been omitted. Now, the amended Act permitted appointment of ‘consultant’ or ‘specialist’ in ‘various fields’ for any purpose. What is more, it had given carte-blanche to do anything without being restrained by the provisions of Sec.17 (2) (a) too.

If only the ‘specialists’ and ‘consultants’ were required for super-speciality services, the said proviso ought to have been inserted below Sec. 17 (3) only. But, that was not to be.

And, what was made of that provision later is beyond the scope of this post.

But, these problems would not have arisen, if only the UPSC had continued to recruit the medical officers as was in position upto 1989.

2015.

ESIC amended the Recruitment Regulations for the Medical Teaching Faculty posts in its medical colleges on 03.07.2015.

The posts of ‘Associate Professor’ are required to be filled by promotion failing which by direct recruitment or deputation or absorption or short-term contract.

The posts of ‘Director Professor’ are required to be filled by promotion failing which by deputation.

The posts of ‘Professor’ should be filled 50% by promotion failing which by deputation, absorption or short term contract and the remaining 50% by direct recruitment.

When there is such a ‘failing which’ clause, it necessitates the authorities to resort to that primary mode of recruitment-process first and then, if the vacancies could not be filled by that primary mode, to go for the secondary mode.

The authorities cannot choose the secondary modes by, arbitrarily, ignoring the primary mode.

2019

Advertisement is issued by the Dean of the ESIC Medical College, K.K.Nagar Chennai inviting candidates for walk-in interview on 17.07.2019 for appointment to the posts of Associate Professor, on contractual basis.

How could the post of Associate Professor for which clear-cut Recruitment Regulations are there, be filled on contractual basis?

Can any authority violate the RR in such a brazen manner?

These problems would not have arisen, if only the UPSC had continued to recruit the medical officers as was in position upto 1989.

Nurses in the ESIC

2017

The ESIC publishes in its website a Memo dated 04.05.2017 a draft Recruitment Regulations for the posts of Staff Nurse, Nursing Sister and Assistant Nursing Superintendent. This draft invites comments also within 30 days. Thereafter the draft RRs are sent to the DOPT and then to the UPSC too.

The salient features of the amendment are:

  1. The posts in the Nursing cadre are re-designated and re-classified as Nursing Officer ( Group B ), Senior Nursing Officer (Group B) and Assistant Nursing Superintendent (Group A).
  2. The recruitment process in respect of all these posts go to the UPSC.
  3. The DPC will be conducted by the UPSC and a member of the UPSC will be the Chairman of the DPC.

 05.07.2019

The UPSC has given its ultimate approval to the RRs vide its letter dated 05.07.2019. The selection process of the posts in the Nursing cadre has, now, been taken over by the UPSC. In fact, the original proposal sent by the ESIC on 04.05.2017 has come out unscathed as could be seen from the UPSC’s letter dated 05.07.2019.

The Recruitment Regulations are framed by the ESIC as a body, for all the posts in the organisation. They are prepared as per the Regulation making power vested in the ESIC as per Sec. 97(xxi) of the ESI Act, 1948. While all other Regulations framed by the ESIC with reference to Sec. 97 (i) to (xx) and Sec. 97 (xxii) and (xxiii) can be brought into force only after they are notified in the Gazette, Sec. 97 (xxi) had been, specifically, exempted from such pre-publication for enforcement, as per Sec. 97 (2A).

Sec 98 xxi

Sec 98 2A

The authorities of the ESIC have to and can enforce it from the very day on which they receive the RRs from the UPSC (in respect of Group A and B posts) or from the DOPT (in respect of Group C and D posts, where necessary, although the DOPT does not insist on its oversight on such RRs in certain circumstances).

New RRs of Nurses have already come into existence.

In the case of the RRs for the posts of Senior Nursing Officers and the ANS, the RRs approved by the UPSC and forwarded to the ESIC on 05.07.2019 have already come into existence, as per law. It is not permissible to argue that these RRs would come into effect only after they are notified in the Gazette.

In order to remove any confusion, it is clarified that the period of ten weeks mentioned in the letter of the UPSC for notifying the RRs in the Gazette is not the time given to the ESIC to, arbitrarily, postpone, for ten long weeks, the date on which these RRs become effective. Sec. 97 (2A) precludes and prevents such bureaucratic arbitrariness.  

The ESIC has, in its letter dated 12.07.2019 taken a decision to convene the DPCs as per the “existing” RRs of the posts in the Nursing cadre.

That is the correct stand. But, that “existing” RR as on 12.07.2019 for the posts of ANS and SNO are only the latest RRs forwarded by the UPSC on 05.07.2019.

Let the power vested in the UPSC, now,  for initiating recruitment process  for the posts of ANS and SNO be exercised only by the UPSC as per the existing RRs, i.e., the RRs received from the UPSC vide their letter dated 05.07.2019.

Let the Region-wise seniority list of Staff Nurses of all the Regions be merged together to prepare an all India seniority list in the cadre of Nursing Officer, which is the feeder cadre for promotion to the post of Senior Nursing Officer. It can be done in the same way it is done for merging the regional seniority lists of Assistants for promotion to the cadre of SSOs at all India level.

Let that seniority list be finalised and sent to the UPSC for initiating selection process at their level to fill up the vacancies in the cadre of Senior Nursing Officers and Assistant Nursing Superintendent.

This is the legal requirement as per Sec. 97 (2A) of the ESI Act, 1948 read with para 3 in the letter No. A/11/11/12/2018-Med. VI. dated 12.07.2019 of the Hqrs. Office.

The stress is on the phrase ‘shall not apply‘ as found in Sec. 97 (2A). It says ‘shall not’. It is mandatory that the ESIC should not wait for publication of the RRs in the Gazette for and before enforcing them. Those RRs sent by the UPSC on 05.07.2019 hold the field today.  This is the position of law. The ESIC Medical Division cannot withhold the RRs sent by the UPSC on 05.07.2019 and hold DPC for the post of ANS and Nursing Superintendent as per the, by now, old and non-existent RRs.

It is time the Doctors followed the Nurses.

Let the recruitment process of IMOs be handed over back to the UPSC.

 

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Shortage of doctors in the ESIC Hospitals: Where did the home-grown PGs go?

The Administration of the ESIC has chosen to transfer large number of IMOs from Bangalore and Chennai to far off places in the North. The reason advanced is that they are surplus medical officers here. But, the fact is that the number of patients has been increasing multifold requiring more medical personnel.  Besides, it is a paradox that while the regular doctors are transferred out, there are many doctors engaged on contract basis and they are allowed to remain.

The doctors transferred are told that they were granted Study Leave “for personal growth” in their “career”. It is also said that the ESIC obliged them and “contributed to their personal growth by granting them study leave”.

But, the fact is otherwise. As per Rule 50 of  the CCS (Leave) Rules, Study Leave is to be granted only “with due regard to the exigencies of public service“. As per Rule 50 (3) of the CCS (Leave) Rules, “Study leave shall not be granted unless it is certified by the authority competent to grant leave that the proposed course of study or training shall be of definite advantage from the point of view of public interests. Moreover, as per a Proviso under the aforesaid Rule 50 (3), a “Medical Officer may be granted study leave for prosecuting a course of postgraduate study in Medical Sciences if the Director-General of Health Services certifies to the effect that such study shall be valuable in increasing the efficiency of such Medical Officer in the performance of his duties.”  It is only when the authority considers that granting Study Leave to a person would be useful and definitely advantageous to the organisation that Study Leave is granted. It is not  and  it cannot be done as a charity.

The ESIC which utilises the services of the Medical Officers who were sent outside on Study Leave, is now transferring them to far-off places in a selective manner. At the same time, something  peculiar had already happened.

The ESIC authorities had, in a fit of frenzy,  set up large number of medical colleges in 2011 and 2012, at a stretch and justified that action before the Court also in the W.P. 12953 of 2015.

Home-grown Post-Graduates 

Those medical institutions were intended to produce PG students and make use of their services for a specified period of service as per the terms of the Bond executed by them.They had to execute a bond to serve the ESIC for specified period of years.

 

But, although the ESIC Medical Colleges had been producing many post-graduates, they were sent out, without their services being used  in the ESIC hospitals, anywhere, across the nation. How many such  Post Graduates churned out by those colleges from the year 2014 onwards were let off without the ESIC utilising their services is not known. But, around 500 were being sent out every year from 2015 onwards. They were, simply, let off.

Strangely, the newspaper Livemint had reported on 16.12.2015 that “the labour ministry has rejected a plan to mandate a Rs. 25 lakh bond on students enrolling in medical colleges run by the Employees’ State Insurance Corporation (ESIC), fearing the move could have been seen as anti-people”. That was really puzzling! For, that was an unlawful decision!

 

What is more? The Livemint reported, “Instead of the bond plan, Kataria said, ESIC will now offer students a 100% placement as soon as they complete the courses. “In 2016-17, we will absorb the 100 doctors graduating from our medical colleges, and by 2019-20, we will absorb 500 of them,” Kataria said. “It’s a 100% placement for our own students in our hospitals.” In that case, all those post graduates should have been posted in the ESIC hospitals. But, that was not done.

If only that bond had been executed, those PGs’ services could have been used by the ESIC as IMO-Gr. II for, at least, five years. Why did the ESIC use the workers money to produce PGs who were not of any use to the organisation, at all? Is that not anti-people?

It is even more puzzling, how the Administration is now transferring the doctors from the existing hospitals and sending them out to places in other states. The lack of knowledge of the local language, which is a prime factor, in the appointment of doctors, has not been taken into consideration at all.

The 2006 Transfer Policy for Medical Officers

It is true that the IMOs of the ESIC are subject to all India transfer liability. But, in the year 2006, a policy decision was taken and circulated too, informing the Medical Officers that inter-regional transfers would be effected only when they get promotion to the Senior Administrative Grade. It is that decision which holds the field till date.

Selective application of all-India transfer liability

Moreover, if at all, there has to be Rationalisation, the Administration should fill up the vacancies in all the centres by transferring all the people everywhere in a cyclical manner  and not just from a few centres in the South to a few centres in the North.

It is a fact that there is patent discrimination by the Administration in the matter of transfer of officials, depending upon their States. It is a long-time anomaly. The transfer policies brought in, in the year 2005, to set right this anomaly and to ensure  impartiality, uniformity, universality and predictability in the matter of transfer of officers have been silently buried and forgotten by the Administration.

Striking the balance between public and private interests in transfers

Hon’ble High Court of Kerala has held that the “right to transfer an employee is a powerful weapon in the hands of the employer. Sometimes, it is more dangerous than other punishments. Recent history bears testimony to this. It may, at times, bear the mask of innocuousness. What is ostensible in a transfer order may not be the real object. Behind the mask of innocence may hide the sweet revenge, a desire to get rid of an inconvenient employee...”Asserting that there can a “deceptive innocuousness” in the transfer orders, the Hon’ble Court said, “atransfer can uproot a family, cause irrepairable harm to employee and drive him to desperation.”  {Pushpakara Vs Chairman Coir Board, Cochin 19.12.1977- (1979) ILLJ 139 Kerala)and in llyas Ahmad Vs Station Director, All India Radio, Hyderabad (1979 – 2.5 LR -58, 1979-Slj -592. K. K. Jindal Vs. General Manager, Northern Railway}.

Colourable exercise of power

Hon’ble Supreme Court of India has observed, on 25.8.2003, that “Transfer is an incidence of public service and the power to transfer is available to be exercised by the employer unless an express bar or restraint on the exercise of such power can be spelt out.  The power, like all other administrative powers, has to be exercised bona fide”.  (State of Rajasthan & Ors  Vs. Anand Prakash Solanki –C.A.NO. 6733 OF 2003). If there is shortage of officials / medical officers in one region, the Administration should make it a routine to transfer all the officers everywhere in a cyclical manner and post them everywhere. Holding out the condition of all-India transfer liability only to one section of officers / doctors amounts to selective discrimination, through arbitrary and colourable exercise of power.

“One cannot but deprecate that frequent, unscheduled and unreasonable transfers can uproot a family, cause irreparable harm to a Government servant and drive him to desperation. It disrupts the education of his children and leads to numerous other complications and problems and results in hardship and demoralisation. It therefore follows that the policy of transfer should be reasonable and fair and should apply to everybody equally. But, at the same time, it cannot be forgotten that so far as superior or more responsible posts are concerned, continued posting at one station or in one department of the Government is not conductive to good administration. It creates vested interest and therefore we find that even from the British times the general policy has been to restrict the period of posting for a definite period. We wish to add that the position of Class III and Class IV employees stand on a different footing. We trust that the Government will keep these considerations in view while making an order of transfer”, observed the Supreme Court in Varadha Rao vs State Of Karnataka And Ors. on 26 August, 1986.

Students are not substitutes 

The ESIC Administration should not make any attempt to show the PG Students as Doctors. Students cannot be shown as substitutes for doctors. Besides, they had not been taken into account to calculate the Sanctioned Strength of medical officers or to arrive at the findings on the so-called Rationalisation, in the hospitals both in the South and in the North.

Double-speak impermissible

An organisation that officially declared some doctors as those belonging to teaching faculty cannot take a different stand stating that it did so just in order to help those doctors to have an impressive CV. That would be a confession in having cheated the MCI. No law permits anyone to approbate and reprobate at one and the same time.

What fairness necessitates

It is only fair that the existing doctor-patient ratio is not disturbed, specially when more and more patients are coming in to these Hospitals for treatment. It is necessary that less number of doctors are not made to take care of more number of patients.

It is only fair that the vacancies, if any, at other places are filled,  not by posting only the doctors from the South but by evolving a uniform policy that applies to all the doctors everywhere.

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CAG in December 2015 on ESIC Medical institutions !

I. 
Submission in the W.P. 12953 of 2015 filed in April 2015 and in the W.P. 18773 of 2015 filed in June 2015 before the Hon’ble High Court of Madras at Chennai:
“In the circumstances, the decision taken by the Respondent-2 (Director General) on 05.01.2015 to quit medical education and not to admit new batch of students is a correct one and it was intended to salvage whatever is left of the ESI Scheme and to prevent it from getting drowned”.
Findings of the CAG as per the Press Release in December 2015:
“Corporation decided to exit from the field of medical education in its 163rd meeting held on 4th December 2014 as it was not one of its core functions. The decision to exit from this endeavour was only an exercise to limit the liability” (Para 2.12).
II. 
Submission in the W.P. 12953 of 2015 filed in April 2015 and in the W.P. 18773 of 2015 filed in June 2015 before the Hon’ble High Court of Madras at Chennai:
“But, the decision taken all of a sudden on 14.07.2007 during the meeting of the ESI Corporation to establish 43 medical educational institutions in 17 states of India commenced the era of impedance in the functioning of the ESI Scheme. All of a sudden the ESIC started to enter into the field of medical education. And that too on a large scale at the initial stage itself without even testing waters through Pilot Project.”
Findings of the CAG as per the Press Release in December 2015:
“Due diligence, if any, carried out to ascertain the number of colleges required to be opened, to fulfill the future requirement of doctors and other paramedical staff was not available”. (Para 2.6).
“The organisation also did not have any concept paper or project report to assess the viability of opening medical colleges or alternatives to cope up with the shortage of medical personnel in the ESIC hospitals, the CAG said.” – Business Standard 18.12.2015.
For more:
and

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The fine art of squeezing out the ESI Fund Account No. 1.

 

The ESI Corporation Minutes dated 17.07.2007 shows that the decision to open medical colleges had been taken in that meeting, in spite of the fact that there was no formal agenda on that subject and no discussion on that subject. The Sub-Committee that was constituted, later, in 2008 to formulate proposal for amendments on various issues, recommended setting up medical colleges on the condition that the “doctors and paramedical staff would be required to render such minimum service in ESI hospitals / dispensaries / institutions as may be decided by the Corporation”.

ESI Medical Bond

 

The Insured Persons whose money was to be spent for this purpose and the Parliamentarians who approved the amendment to insert Sec. 59-B had been given the impression that there was something for the Insured Persons in return for the money collected from them (whether it was proportionate or not is beside the matter).

As the intention was only to fritter away and misappropriate the surplus funds, the authorities did not wait for the essential procedure of formal amendment to the ESI Act, which actually came in the form of Sec. 59 B of the Act only in May 2010 effective from June 2010. They initiated the construction work for so many medical institutions throughout the nation, in a tearing hurry, in the year 2008 itself, and spent about Rs. 10000 crores even before the Act was amended. They did not exhibit ordinary prudence and caution by having a proper and objective in-depth study of the pros and cons of starting medical institutions by the ESI Corporation. They did not even try with a few pilot projects. They started constructing buildings, at one go, for large number of medical colleges including nursing colleges and colleges for para medical staff.

There was never any felt need for the ESIC to start medical colleges to recruit the MBBS-qualified doctors let alone nurses and para-medical staff to run their dispensaries and hospitals. The ESI Corporation had always been getting overwhelming response to its advertisements to recruit MBBS-qualified doctors, BDS qualified doctors, nurses and other para-medical staff. For instance, there had been 3000 applicants when the recruitment process was for 300 vacancies of MBBS-qualifed doctors. Yet, the authorities started constructing about 23 buildings throughout the nation and all of them have now become white elephants. Now, in the year 2014, their own Sub-Committee on Medical Services & Medical Education said that running the medical colleges would result in the budget becoming negative in the year 2016-17.

Hon’ble Minister for Labour Mr. Narendra Singh Tomar has said that “the decision to open medical colleges by the ESIC was a big mistake”.  

Calling the ESIC board’s decision to open medical colleges in 2008-09 a “big mistake”, labour and employment minister Narendra Singh Tomar said he will review the scheme.“The decision to open medical colleges by ESIC was a huge mistake and we will rectify it,” Tomar told reporters after a meeting of the ESIC board comprising representatives of workers, industry and government.

The Financial Commissioner said that the ESIC did not have the core competency:

“Medical education is not our core competency, and we would prefer to focus on our primary job—providing medical care services to industrial workers,” said S.K. Rahate, finance commissioner, ESIC. “We have learnt from experience over the last five years.”

Live Mint reported:

“These are high cost projects causing a significant outflow of funds on both capital as well as revenue accounts. This will in near future cause the ESIC expenditure to be more than its revenue income,” said an internal note based on an ESIC sub-committee report. Mint has seen a copy of the note.”

That Note, the Report of the Sub-Committee  on Medical Services & Medical Eduction submitted in May 2014 discussed at length about the system of Bond that had to be obtained from the students who were given subsidised education from the ESI Funds. In Para XIII (6) in Page 51 of the Report, the Sub-Committee had observed that the ESIC could not subsidise the medical education, when the Bond was not for recovering the full recurring cost. The said para read as under:

“If full recurring cost is to be recovered from UG/PG students, it would require charging very high fees; or, the corresponding Bond amount would need to be very high. If the fees/Bond amount is to be reduced, it would require subsidy for medical education from the ESIC. This may be violative of the spirit of the ESI Act.”

Page 31 of subcommittee report on ME

In Para XIII (5) (e) of the Report, the Sub-Committee had said, “That there was no system of bond enforcement and without an effective enforcement of bonds, the availability of doctors to the Corporation would not be assured.”

 

Now, all of a sudden, the insured persons are informed that the so-called precautions taken by them, as narrated above, can be and have been thrown to wind. 

This announcement is made even before the first batch of undergraduate students is out and on the verge of their being out, by the summer of 2016. The ESIC does not say that there is no vacancy to accommodate the newcomers. The ESIC says that obtaining such bonds would be considered as anti-people move.

“Since ESIC has spent thousands of crores on medical colleges, it is unfair for students who get subsidized education and then join the private sector, a labour ministry official said. “So, the Rs.25 lakh bond plan was mooted, but in the current political environment, such a move has been put on the back-burner,” the official said, requesting anonymity.”  (http://www.livemint.com/Politics/yJigrCBGE3RY3oBhGp7A2H/Govt-scraps-planned-Rs25-lakh-bond-for-ESIC-medical-students.html)

This is not a correct decision. The reason publicly proclaimed does not appear to be the right one. The money of the Insured Persons cannot be frittered away by the politicians and bureaucrats thus.

Politicians and Officials

 

Such an awakening that the enforcement of Bond would be seen as an anti-people move did not come in 2007 or 2008, before venturing into the area of medical education. Besides, such Bond system is in vogue as per the CCS (Leave) Rules, 1972,  governing the sanction of even the Study Leave. Nobody has termed it as an anti-people move, during the past 43 years.

In the circumstances, some Insured Persons are already taking action to move the Hon’ble Court to seek its intersession, against this kind of arbitrary decision in the name of Policy Decision.

The copies of the Agenda and the Minutes of the meeting of the ESI Corporation in which such a decision has been taken have, therefore,  been sought for under the RTI Act. But, if any of the readers happen to have those documents, through the ESIC Members, they may kindly transmit the same to this website to facilitate early legal action, in the interest of the working population.

Readers may also evaluate for themselves the manner in which benefits made available to the Insured Persons have been reduced post 2010.

1). http://www.outlookindia.com/article/the-gurney-grinds-to-a-sad-halt/295143

2) https://flourishingesic.info/2012/09/27/enigmatic-amendment-2011-that-affect-the-benefits/

3). and the response of Ms. Nisha Parveen below the thread referred to supra.

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Healthcare: Mr. Jaitley leads the nation to peril !

“If we continue in the direction we’re headed we’ll soon have a health insurance system dominated by two or three mammoth for-profit corporations capable of squeezing employees and consumers for all they’re worth – and handing over the profits to their shareholders and executives.

The alternative is a government-run single payer system – such as is in place in almost every other advanced economy – dedicated to lower premiums and better care.”- Robert Reich.

==================================================

“Insurers are seeking rate hikes of 20 to 40 percent for next year because they think they already have enough economic and political clout to get them.

That’s not what they’re telling federal and state regulators, of course. They say rate increases are necessary because people enrolling in Obamacare are sicker than they expected, and they’re losing money.

Remember, this an industry with rising share values and wads of cash for mergers and acquisitions. It also has enough dough to bestow huge pay packages on its top executives.

The CEOs of the five largest for-profit health insurance companies each raked in $10 to $15 million last year.

After the mergers, the biggest insurers will have even larger profits, higher share values, and fatter pay packages for their top brass.

There’s abundant evidence that when health insurers merge, premiums rise. For example, Leemore Dafny, a professor at the Kellogg School of Management at Northwestern University, and his two co-authors, found that after Aetna merged with Prudential HealthCare in 1999, premiums rose 7 percent higher than had the merger not occurred.” – Robert Reich. ===================================================

In India, the problems would be worse, when private players are allowed to play a role in providing social security. The profit would not be shared with shareholders too. It would be shared with the politicians, as black money.

That is the reason the Indian politicians find it irresistible to yield to the desires of the ultra-rich and make the common public the fodder to feed those ultra rich.

We know this happening already in the Telecommunications sector. The BSNL and MTNL had the wherewithal to provide cable TV connection to all homes and provide all the channels the people wanted. But, they were not encouraged. Will these public sector organisations pay anything to the politicians overtly and covertly? What is the use of these organisations for them? But, the private players in the field rake in a lot and throw a share to the politicians in the name of party-funds, who do not want to make the source of their party funds transparent but share the booty among themselves for which they became politicians first and rulers next. One can compare the remuneration of the chief of Airtel with the chief of BSNL and find who is there for what.

Likewise one can compare the remuneration of the lowest paid clerical staff of the BSNL with his counterpart in Airtel and find who is better off. The modern CEO would ensure that wages fall and profits rise. He would ensure his voice is heard and obeyed while the voice of the employees would never be allowed even to be raised.

Privatisation helps the top man to suck the blood of the public and the subordinates to enrich himself.

These politicians who are after money-bags would not save the nation by privatising Social Security. Their thoughtless action is going to make the life of the future generations miserable.

Mr. Arun Jaitley has said in Para 62 of his Budget speech,”With respect to ESI, the employee should have the option of choosing either ESI or a Health Insurance product, recognized by the Insurance Regulatory Development Authority (IRDA). We intend to bring amending legislation in this regard, afterstakeholder consultation.”. What this forebodes the nation can be seen from the problems faced by the commoners in the USA. The situation in India would become worse.

Let us,therefore, knock at the doors of Judiciary to save the nation from the hands of these greedy politicians, who had already corroded the public sector health care system by their interference and cite the same corrosion as the reason to bring in private players to spoil the nation.

For more: http://www.salon.com/2015/07/07/robert_reich_single_payer_healthcare_is_the_only_way_partner/?utm_source=facebook&utm_medium=socialflow

As rightly analysed by Mr.Reich in some other article, modern day businessmen are not required to be brilliant. He says that the modern day corporate CEO is one “who’s rigged the rules, reaped giant personal rewards, and left communities and employees stranded.” But, the men in power to control the government and the media make the government to propagate and convince the masses that the modern day businessman is a messiah to save the mankind.

Only the awakening of the masses can save their progeny!

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ESIC should not admit students again: AITUC in HC !

The Tamilnadu State Council of the AITUC has filed a case in the Hon’ble High Court of Chennai in W.P. No. 18773 of 2015 praying for quashing the decision communicated by the Hqrs. Office of the ESI Corporation on 18.03.2015 to admit students again in the ESIC-run medical institutions for the year 2015-16.Mr.T.M. Murthy, General Secretary of the Tamilnadu wing of the AITUC has moved the Hon’ble Court on this issue. Mr.P Gurusamy, the Counsel for the AITUC, said that the Hon’ble High Court admitted the case and permitted issue of private notice to the parties.

The argument of the AITUC is:

  1. The membership of the AITUC is 3.6 million. The unions affiliated to AITUC are from textile, engineering, coal, steel, road transport, electricity board and of unorganised sector such as beedi, construction and head-load workers, anganwadi, local bodies and handloom. The employees who are working in various factories and establishments in India are members of our trade union too and they have been covered under the provisions of the Employees’ State Insurance Act too. The ESI Corporation as a body, had taken decision on 05.01.2015 quit medical education, as the ESIC did not have the core competency to run the medical institutions. But, it had been reversed by the Director General on 18.03.2015 and decision taken to admit the students in the ESIC Medical institutions for the year 2015-16, without any justification, as his decision results in further wastage of the funds contributed by the members of our AITUC, who are working in various factories / establishments coverable under the ESI Scheme.
  2. The AITUC has submitted that the ESI scheme had been well managed at the macro level up to the year 2007. The article in the Economic Times on 05.02. 2003 commended the financial management of the ESIC in an article titled “ESI manages funds better than pvt units”. The article said, “Next time you grumble about the Employees’ State Insurance Scheme, you could get some solace from knowing that at least your money is being managed well.” The article goes on emphasing this aspect at length. This Central Autonomous Body had been accumulated funds little by little for about 55 years and kept them invested in government securities as per the advice of the Respondent-5 from time to time. And this made the organization financially strong.
  3. But, the decision taken all of a sudden on 14.07.2007 during the meeting of the ESI Corporation to establish 43 medical educational institutions in 17 states of India commenced the era of impedance in the functioning of the ESI Scheme. All of a sudden the ESIC started to enter into the field of medical education. And that too on a large scale at the initial stage itself without even testing waters through Pilot Project.
  4. The obvious intention was only to fritter away the corporation money on a large scale in construction of buildings rather than establishing medical colleges and running them successfully forever. That was the reason the Respondents ventured to start so many medical colleges at one go. They did not even do paper work to assess the initial cost and the perpetual running cost vis-à-vis the revenue earned in the form of contribution from the workers who are members of our AITUC too. The Ministry of Law and the Ministry of Finance had also been indifferent to the activities in the ESI Corporation and had cleared the proposal of the ESIC for amendment in the year 2010 without proper examination.
  5. The Director General had indulged in construction spree on an extensive scale and frittered away 15000 crores of rupees so far. Around 8 medical institutions have started functioning from the academic year 2011-12. The running cost is enormous and is affecting the routine and main work of the ESIC. Now, the Sub-Committee of the ESIC reports that the budget will be negative in 2016-17.
  6. In the circumstances, the decision taken by the Respondent-2 on 05.01.2015 to quit medical education and not to admit new batch of students is a correct one and it was intended to salvage whatever is left of the ESI Scheme and to prevent it from getting drowned.
  7. But, the decision taken on 18.03.2015 to admit new batch of students for the year 2015-16 is patently wrong and is in deviation of the decision communicated by the Respondent-2 earlier on 05.01.2015. When the ESIC had openly admitted in categorical and clear terms that it did “not have the core competency to run the medical institutions”, there should be no further attempt to spoil both the organization and the career of the new batch of students.
  8. Besides, this decision dated 18.03.2015 is ultra vires as it was in defiance of the earlier decision dated 05.12.2014 of the Apex body. The decision taken on 18.03.2015 was not only unlawful, its being ultra vires of the Respondent-2 but also unjustifiable ex facie. The order dated 18.03.2015, therefore, needs to be quashed in the interest of vast multitude of workers in the nation.

The AITUC has reiterated its case on the following Grounds:

A.   59-B of the ESI Act which lays down the provisions for “Medical and para-medical education” says, “The Corporation may establish medical colleges, nursing colleges and training institutes for its para-medical staff and other employees with a view to improve the quality of services provided under the Employees’ State Insurance Scheme.” However, four years later, the Respondent-2 found that the ESI Corporation did not have the core competency to run medical colleges and that “the objective of Section 59-B is unlikely to be met”. His earlier decision to enter into medical education has, thus, been proved to be wrong by the order dated 05.01.2015 issued by the Respondent-2 himself. The Respondent-2 ventures to commit another wrong now, through his subsequent order dated 18.03.2015, in spite of his realization of his own earlier mistake. He should, therefore, exit from the field of medical education at the earliest opportunity, as decided by him on 05.01.2015, without spoiling the career of the students who want to be taught by competent and willing institutions.

B.  The ESI Corporation, as a Body, decided, on 04.12.2014, that the ESIC should exit the field of medical education as that was not the core function of the organization. It was decided to phase out the existing four medical education and dental colleges in a phased manner or to close them down by apportioning the students among other colleges, “whichever is earlier”. But, all of a sudden, the Respondent-2, who is not empowered to act in violation of the decision of the Apex Body, does turn the decision upside down and issue a circular on 18.03.2015 directing the Deans and Medical Superintendents of the concerned Medical Colleges to initiate action to admit students for the next batch of the year 2015-16. It is not only ultra vires of the Respondent-2 to do so but also a deliberate misconduct on his part.

C.  It has been mentioned that this decision dated 18.03.2015 had been taken in the “interest of the students”. But, the unassailable fact is that the interest of the existing students in the MBBS/ BDS/ PG course do not get served by admitting new students. The reason given by the Respondents in the aforesaid Memo dated 18.03.2015 is false and is intended to mislead the public. An organization that wants to exit medical education for lack of core competency to run it, cannot protect the interests of any students and that too new batches. Their statements and actions are mutually contradictory and self-defeating. The Respondent-2 are not transparent in their activities and do not come out with facts which prompted them to act, unlawfully, in total defiance of the decision taken by the Apex body on 04.12.2014. Their statement that their mysterious decision dated 18.03.2015 was taken ‘in the interest of students’ is patently wrong a clear attempt to cover up their real and obviously questionable intention to waste the ESI funds even more. I respectfully submit that the Memo. dated 18.03. 2015 needs to be quashed on this score itself.

D.  The Respondent-2 had already incurred around Rs. 15000 crores to construct and run many medical colleges at one go. Now that he has admitted that he does not have the competency to run medical colleges, that the objective of Sec. 59-B of the Act is unlikely to be met and that running medical colleges is not the core activity of the ESIC, he must act as the man of ordinary prudence, as mandated very often in the General Financial Rules, 2005, and stop further admission of students to these five institutions. But, I feel aggrieved that the Respondent-2 ventures to misspend the funds contributed by me and on my behalf and other similarly-placed insured persons knowing full well that he does not have the competence to teach those newly admitted students too.

9.   The AITUC has, therefore, prayed that the Hon’ble High Court may be pleased to quash the Memo. dated 18.03.2015 and consequently direct the Respondents not to admit students for 2015-16 session in MBBS/BDS/PG courses and to pass further or other orders as deemed fit by the Hon’ble Court and, thus, render justice.

 

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Moving the Court of Law; Inviting ideas and opinions from the public !

Democracy means having the right to say what one wants and leaving the decision to others*. But, what one says must be right and true. This website makes every attempt to present the ‘right’s and the ‘truths’. And, this website never claims that what it presents alone is right. It is for the reader to discern what is right and what is wrong, as the website is open for different viewpoints and has hosted articles received by it with contrary views.

This website reiterates that it serves only as a forum to bring out the opinion of the public so that the authorities are able to traverse beyond their immediate circle and take informed decisions. The website would also enable the Ministers and Prime Minister to realize the seriousness of their mistake in forcing the bureaucrats to put up convenient notes to justify the pro-rich decision already taken by them, ignoring the pain that would be inflicted on the society by such improper political decision.

 Wrong decisions by Elected Bodies

 Now that the ESI Corporation, as a body, has realised, in its 163rd meeting, that running the medical colleges is not its core activity (and that too, after the amendment of 2010 which made the medical colleges, part of the ESIC) the issue becomes how and why the same ESI Corporation, as a body, considered, in the years 2008 and 2009, that running the medical college was essential for it, “to improve the quality of services provided under the ESI Scheme” and permitted spending the surplus funds running into more than Rs. 9000 crores, in a tearing hurry, and hundreds of crores were sanctioned first and placed later for approval ex-post facto by the Standing Committee, for construction of medical college buildings, even before the formal amendment was made to the ESI Act to empower the ESIC to “establish” medical colleges.

The fact, therefore, is that the ESIC, as a body, took a wrong decision either before the amendment or, now, after the amendment. The indisputable fact is that the ESIC, as a body, has demonstrated that it could and would take wrong decisions.

 Failure of Members to play their legitimate role

 But, the concept of having a multi-faceted body for decision-making is that there should, normally, be informed discussions in the meetings so that there would be no scope for such patently wrong decisions. But that was not to be in the case of ESIC when it came to spending thousands of crores of rupees for construction of buildings for medical colleges, even before the enactment of law. The ESI Corporation, is a Body in which there are, among others,

  • 10 employers’ representatives,
  • 10 employees’ representatives,
  • 3 MPs, and
  • 25 IAS Officers representing various State Governments.

Yet, such wrong decision had been taken in the ESIC meetings, only because of the failure of the employers’ representatives and employees’ representatives (except Mr. Kali Ghose) to examine the proposal with the seriousness it deserved. The representatives of the State Governments used to remain silent spectators in almost all the ESIC meetings, except when the issue involved their States. But, their presence had always lent credibility to the claim of their consent to the decision in the Body by showing them as part of the affirming majority. In essence, majority of the members of the ESIC did not show active interest, in the years 2008 and 2009, in examining the proposal tabled for their consideration, for insertion of Sec. 59-B. Hence the present predicament.

 Failure of the media to prevent the catastrophe

 Yet, even in those years of origin of the present problem, there had been some activists who had been working hard to prevent the catastrophe and to enlighten the MPs about such a wrong decision and the unlawful action in spending crores of rupees for construction of buildings for medical colleges, even before the Parliament amended the Act. But, the MPs did not care. Those activists wrote to various newspapers too, including the “National”ones. But, no editor cared. The Parliamentary Standing Committee was cheated. And, in the last leg, the Parliamentarians chose to be busy with creating pandemonium over Mr. Sibu Soren issue while Mr. Mallikarjun Kharge could present the amendment, amidst interruptions and interruptions, and get it through. The result was a puzzling proposal for amendment became law with an ‘amazing’ and improper Validation Clause. That was how the ESI Corporation, as a Body, the Parliamentary Standing Committee, as a Body, and the House of the People, as a Body, had erred and failed to live up to the purpose for which they were there. They had failed to analyse the present and foresee even the easily foreseeable future.

 Atlas is looking for another shoulder

 And, the burden of that error and failure, has been passed on by the earlier Administration to the shoulders of the present Administration, which is searching desperately for other shoulders to shift its burden. Atlas who got the burden of the globe shifted to his shoulders is still trying to find someone else to shift it off. The issue now is whether Atlas can continue to shoulder the burden or should shift it to someone else or whether he can make use of it, in any other manner, without shouldering it as a burden.Atlas 4 The decision in the 163rd meeting of the ESI Corporation that running the medical colleges is not its core activity is right. But, handing over the buildings to the State Governments or private players does not appear to be right. The members of the ESIC do not seem to have discussed the issue in-depth. They appear to have remained silent and endorsed the already made up bureaucratic stand on the issue. It is a clear failure of the present ESI Corporation, as a body. Its decision to shift the burden to the State Governments or to the private players do not seem to be correct and right. But, what are the other options open for the ESIC to make the best out of the present quandary? Are there ways to come out of the quagmire?

Of course, people come up with a variety of ideas. Some may be right. Some may be wrong. Some may be legal. Some may be unlawful. It is felt appropriate to examine all the options in an open forum so that the best comes out of it to facilitate the Administrators to consider those options.

 Thankfully, many are public-spirited

 Some well-intentioned activists believe in taking up the issue to the Court of Law. The relevant questions on the issue are, therefore, brought to the attention of the public, seeking their opinions on them. The questions and the replies given by the public would be presented before the judiciary as a document in the Typeset when the Writ is filed.

Every single citizen has a say in the matter and a stake in the well-being of the ESIC, as an organisation meant to take care of complex life problems. The website, therefore, invites readers to record their viewpoints on the crucial issues so that the best solution emerges out of such brainstorming event for the common good.

“I am only one; I cannot do everything.

Still, I am one; I can do something.

Because I cannot do everything,

I will not desist from doing something that I can do”,

-Helen Keller.

===========================================

The first case to be filed in the Court will focus on the manner in which the ESIC proposes to utilise the buildings which are constructed for running medical colleges. Hon’ble Minister for Labour has made the stand of the Government public in the Press Release dated 23.03.2015. That Press Release will be the impugned document.

 Press Release 23. 03.2015

 The Press Release dated 23.03.2015 says that the ESI Corporation is going to hand over 8 medical colleges, at Faridabad, Sanatnagar, Coimbatore, Gulbarga, Mandi, Alwar, Paripally and Bihta to State Governments as per its revised terms and conditions. It has been mentioned that if the State Governments do not come forward to send any reply within 15 days, it would be presumed by the ESI Corporation that they were not interested in taking over those projects and, thereafter, efforts would be made to run these medical colleges under PPP model etc.,

It has also been specified therein that “the core function of the ESIC is to provide social security i.e., cash benefit and medical benefit to the Insured Persons under the ESI Scheme. It was felt it would help the ESIC in concentrating at its core function if the ESIC exited from the field of Medical Education”.

 White elephants, so many!

 It is apparent from the said Press Release that the present ESI Administration finds it difficult to run the Medical Colleges and does not know how to get rid of so many white elephants. It says it is trying to hand over the “Medical Colleges” to the State Governments, on its own terms and conditions.

The Ministry of Labour is also ready ( Or, eager?) to hand over those “Medical Colleges” to private players, as could be seen from the Press Release dated 23.03.2015. It uses the term ‘PPP model’. It also uses, significantly, the word “etc” to indicate that it does have more options too.

The Press Release gives raise to various questions, some of which are enumerated below:

  1. Where is the provision in Sec. 59-B to empower the ESIC to run the “medical colleges” through private players or even through State Governments? Such third party participation is permitted by Sec. 59 (3) only to run the ESI Hospitals and not Medical Colleges. How can the ESIC mix up Sec. 59(3) with Sec. 59 (B)?
  2. Besides, the basic issue is, where is the continued need for the ESIC to run medical colleges and also to seek PPP for that purpose, when it has found out that it is not its core activity, at least, now?
  3. When the Administration has admitted that the buildings of 8 more medical colleges are only “under construction”, why should it not forget about medical colleges but use the infrastructure created, for some other purposes, in such a manner that it generates permanent rental income to the ESIC to add to the ESI Fund, to offset the money lost during the last six years?
  4. Is it obligatory for the ESIC to run those medical colleges through proxies, either through the State Government or through PPP or through other methods (as implied from the world ‘etc’), just because buildings have been constructed or just because the MCI is going to give permission to it?
  5. When the Private Players are allowed to run the medical colleges, will they be running it as per their own licence or by using the licence obtained by the ESIC from the Medical Council of India?
  6. If the ESIC is using the licence obtained by it for running the medical colleges and allowing that licence to be used by the private players, will it be legal, when the ESIC has gone on record saying repeatedly that running the medical colleges is not its core activity?
  7. Would those private players be able to get permission from the Medical Council of India to run medical colleges on their own? Are these private players permitted to be the beneficiaries of the misadventure and discomfiture of the ESIC in having illegally started construction of buildings spending thousands of crores of rupees from the year 2008?
  8. How is it that some private players like Reliance, SRM and others are reported to have already entered the premises of various (proposed) medical colleges at Coimbatore, Joka and other places, officially and inspected the infrastructure under construction?
  9. Is it true that those private players would admit students under Management Quota to make money, using the licence granted to the ESIC for starting medical colleges?
  10. What is the significance of giving only 15 days’ time to the State Governments to accept the Terms and Conditions framed by the ESIC before and for inviting the private players to have a role in running the medical colleges on behalf of the ESI Corporation?

Helen Keller, all

Everyone is, can be and has to be a Helen Keller. Everyone’s ideas count. Actions of individuals count. During the early 1940s there had been many social activists, impartial scientific authorities, in England who had conducted many social surveys of the conditions of life of the people in principal towns in Britain including London, Liverpool, Sheffield, Plymouth, Southampton, York and Bristol.

Helen Keller

Helen Keller

That alerted Winston Churchill to entrust the work of formal study of the issues of Social Security to Sir William Beveridge. The website, therefore, invites all the readers to come up with their ideas and opinions on the issues affecting the working population.

If emerging facts prove what the PMO, Ministry of Labour and the ESIC are going really in right direction in public interest, it will not be necessary to move the court of law on this score. Otherwise, we will have to seek the intersession of the Judiciary to save the nation from the organised attempts of the rich businessmen and pro-rich-politicians to dismantle the finest Social Security of the nation.

(*with due apologies to H.D.Thoreau).

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Railways dumps the proposal for Medical Colleges!

From the Times of India:

NEW DELHI: The railways have shelved former minister Mamata Banerjee’s ambitious plan of setting up medical colleges across the country. Officials said the hospitals run by the transporter are ‘white elephant’ eating up funds while quality of treatment is poor due to non-availability of good doctors.

The cash-strapped transporter cited Medical Council of India (MCI) rules to junk the proposal.

Most of the railway-run hospitals are equipped with massive infrastructure, located at prime real estate, but they don’t have specialist doctors and act as mere referral centres. Even the Central Hospital in Delhi refers most of the patients to private hospitals which was on the railways’ panel.

“The cost of running a hospital is six times more than the bearing the complete cost of treatment of an employee in a private hospital,” said an official, adding nowhere in world railways own and manage hospitals.

The employees can get free treatment if the hospitals are handed over to private players, considering the prime location and huge huge infrastructure, he said.

Another official said cases of alleged malpractices have been reported in supply of equipment and medicines. He also pointed to a big ‘sick and fit’ racket in which doctors allegedly charge money to declare an employee either sick or fit to be on duty.

In 2009-10 rail budget, Banerjee had announced setting up of medical colleges attached to existing railway hospitals through PPP mode to give higher education facilities to children of railway personnel.

“As per MCI rules, medical colleges on PPP mode with government (railway) hospitals are not permitted. The ministry has therefore dropped the proposal of setting up medical colleges,” junior railway minister Manoj Sinha told Parliament.

After Mamata’s proposal, RITES, a railways subsidiary, was awarded the work at an estimated cost of Rs 187 lakh besides service tax for consultancy and preparing bid documents for selection of private partners. RITES had submitted preliminary reports on feasibility studies in Chennai, Secunderabad and Kharagpur for which Rs 29.41 lakh was spent.

Other proposed locations were Barasat, Garden Reach, Kolkata, Hyderabad, Bilaspur, Lucknow, Bhubaneswar, Mysore, Guwahati, Ahmedabad, Nagpur, Jodhpur, Dibrugarh, Bhopal, Jammu and Thiruvananthapuram.

(Courtesy: Times of India. http://timesofindia.indiatimes.com/india/Railways-dumps-Mamatas-proposal-on-medical-colleges/articleshow/45341235.cms

One of the points to Note:

Expenditure for consultation: Sanctioned Rs. 187 lakhs only. Spent Rs. 29.41 lakhs only.

What was the amount paid by the ESIC to the consultant?

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Ms. Mamatha Banerjee happy with the ESI Hospitals in Kolkata!

“The excellent performance of the ESI Hospitals in West Bengal run by our labour department has been recognized by the Centre. An incentive grant of Rs 22.33 crore has been provided, which is first time ever to be received by any ESI Hospital in the country,” the CM posted on her Facebook page on Saturday.For more:

http://timesofindia.indiatimes.com/india/Mamata-Banerjee-praises-Centre-on-Facebook/articleshow/45084287.cms

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Medical personnel for ESIC Medical Colleges

A Medical graduate who passed the examination for recruitment of Insurance Medical Officer Gr. II in the ESI Corporation presents himself before an officer in the ESI Corporation and says, “ Sir, I have been selected for recruitment in the ESI Corporation. I have also been selected for admission to the PG course in the PGI, Chandigarh. What shall I do?”  Without any hesitation, the well-meaning officer advises him to join the PGI. It happened years ago.

In the same year another Medical graduate enters into the office of the Railway authorities. He has also passed two examinations. One, the examination for recruitment as Medical Officer in the Railway hospital and two, the examination for admission in a Post Graduate Medical course. He seeks advice from the Railway authorities. He is advised by the authorities to join the Railways first. And, immediately, thereafter, he is sanctioned Study Leave and permitted to undergo the post-graduation course, keeping lien in the Railways.

Are there provisions in the Leave Rules? Apparently, there is no provision at — first sight. An employee should have put in, at least, three years of service to be given Study leave without pay. So, a new entrant cannot eve n think of doing post-graduation. But, there is a provision for relaxation in Rule 65 of the CCS (Leave) Rules. The Railway authorities invoked the similar provision in the Indian Railway Establishment Code to permit that new entrant to prosecute higher studies.  Rule 557 in Chapter 5 of that Code contains Leave Rules for the Railway employees. The authorities there got a bond executed by that candidate as provided in Rule 530(3)(a)(b) therein.

The candidate has nothing to lose. Railways have everything to gain. They would get a P.G. level doctor after three years who will be with the Railways for a minimum period of five years and draw the salary of only an entry level doctor without the PG qualification. Continue reading

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