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Wednesday, October 13, 2010

An important judgement on medical examination at the time of recruitment


Tribune News Service, October 11, 2010

The Supreme Court has held that when a specialist civilian hospital has certified an individual to be free from a medical disorder, the Air Force cannot stick to its finding that he is medically unfit and thereby deny him a job opportunity.

Upholding an earlier High Court order, a Division Bench of the apex court, comprising Justice JM Panchal and Justice Gyan Sudha Misra, has dismissed a special leave petition filed by the government against the High Court order.

Observing that the process of medical examination by the Air Force, in this case, was “a cause of serious concern”, the High Court ruled that the findings of the Air Force’s appeal medical board could not be sustained in view of the positive findings of the All India Institute of Medical Sciences, New Delhi, especially when the institute had been informed that the petitioner had been rejected from the defence services.

The High Court directed that the Air Force would be obliged to take the petitioner into service and not disqualify him on medical grounds. The Air Force had rejected him for having heart murmur.

The Union of India had contended that the conditions of disease for civilian appointment were different from that of appointment in defence services. The High Court observed that no medical text or journal had been brought to its notice that said that a person might not have a disease if he was looking for a civilian appointment, but that would become a disease when it came to military employment.

“By no stretch of imagination can it be said that for a civilian appointment the heart condition vanishes or is differently defined for a military appointment,” the High Court ruled.

The court had also observed that within the Air Force medical board itself, different diseases and ailments in relation to the petitioner curiously kept coming in and going out. First, there was weight discrepancy and heart murmur. Then weight discrepancy vanished and hydrosil appeared along with murmur and lastly, hydrosil vanished within a day leaving behind systolic murmur.

26 comments:

Col NR Kurup said...

I think the Air Force Medical Authorities were at gross negligence to present the case seriously before the SC. A sickindividual though can sustain the pressures of civil like, he cannot sustain that of the defence service. A slight heart murmus may not be put an embargo in performance of a civil job; but this slight heart murmus cannot sustain the rigous of hard living in defence and might succumb to death. I wish the Air Force Authorities file a SLP

Navdeep / Maj Navdeep Singh said...

@Col NR Karup.

The question was not of a slight heart murmur, the AIIMS had endorsed in this case that there was no heart murmur AT ALL. Again, it was not a question of a person being fit for a civil or a military job but the controversy was whether at all he had the condition reported at the time of recruitment of the IAF. In situations like this, there are two possible situations - there is objectivity and then there is subjectivity. For example, the military can have different standards for aspects such as eyesight than civil employment and a person who makes the grade regarding eyesight for civil service may not make it for defence services, but there are other things which are totally objective, for example, you cannot say that a person has 178 cms height for civil employment but 175 cms for appointment in a military service. Similarly, when a person does not have any kind or degree of heart murmur, one cannot state that he has 'slight' murmur for appointment in the IAF. Here the question being examined was not the degree of cardiac murmur but the very existence of cardiac murmur.

"I wish the Air Force Authorities file a SLP"

The newsreport itself is about the Supreme Court dismissing the SLP filed by the IAF. Three Courts (Single Bench of the HC, Division Bench and then the Supreme Court) have upheld the contention of AIIMS and the fact that the petitioner had been rejected by the IAF was also fully disclosed to AIIMS.

Such incidents should in fact encourage us to improve our internal mechanisms rather than pointing fingers at institutes like AIIMS who have equally competent doctors and super specialists on their rolls, and fortunately, the human body happens to be the same whether a person is wearing a uniform or not.

pied piper said...

I wonder if some one has statistics of cases pertaining to medical disabilities that have been accepted and set aside by the courts. There seem to be hardly any instance where the courts have not set aside the decisions taken by medical boards. An indication of total disconnect or simply a case of apathy on the part of medical boards.

Anonymous said...

Heart murmurs can be easily assessed very OBJECTIVELY with Echocardiography. The Air Force cardiologist must have seen the candidate and done an echo for him. I wonder what happened to the result of that. Echocardiography is a fairly basic skill in the field of cardiology. The Air force should take this seriously and reassess the candidate. If theIR cardiologist is wrong, then he should be sent for retraining as he doesn't even possess basic cardiology skills.

On the other hand, COURTS ARE FAIRLY WHIMSICAL AND EXTREMELY SUBJECTIVE. They keep sending civilian candidates (CPMF) to Army Hospital (R&R) for their medical examination when they have been made unfit by the civilian organization. If army doctors make them fit, nobody seems to be noticing. We are all well aware how doctors in civil government hospitals are willing to give certificates under political/bureaucratic pressures. The pressure tactics which are used
by unfit candidates for being declared fit are unbelievable. Believe me, I've been there.

Anonymous said...

dear navdeep sir,
very well said, we have to be very clear on the terms and conditions of enrolment in the services but we can't be whimsical. the very fact that the medical problem for rejecting the indl was changed thricenshould have been ground enough to reprimand the medical board itself because it meant that the board was looking to justify the rejection and not the fitness of the indl,
amit

ninihala said...

I do not know the case. Nor have I read the judgment and hence it is odious to comment on the case. However, I know that same readings of disability conditions are assessed differently for service purposes and for the purpose of PWD Act, both by Med Bds held at service hospitals.The portin quoted is "The High Court observed that no medical text or journal had been brought to its notice that said that a person might not have a disease if he was looking for a civilian appointment, but that would become a disease when it came to military employment". If this is the crux of the matter, then there is something wrong somewhere. I do not wish to comment upon the judgment.

captainjohann said...

As a civilian pilot in Central government, I have to undergo yearly and bi yearly medical at Air force central medical establishment. But when I had a heart condition which could not be properly assessed( for example my ECG,TMT were positive while my echo cardiography was negative. ) so they asked me to undergo Angiography at AIIMS and then I was cleared to fly.The Army referral hospital was not there. Infact many army doctors were getting training at AIIMS for new equipment like Sress Thalium, 4D dopler etc later.I remember one Group captain who had triple blockage was cleared to fly after he underwent a procedure at AIIMS as per ICAO rules.

Anonymous said...

See the attitude @ Col NR Kurup and many others downline. The basic reaction is arrogance, ignorance & incompetence. Basic conditions can not be altered on whims and whishes. Heart murmur is indeed a subjective as explained by Maj Navdeep. In this case there was deliberate attempt to reject the candidate on some or other pretext. Subsequently, every attempt has been made to support the wrong doings of few arrogant officers, who wanted to show they are superior to any other organisation be it one that taught it the basics (AIIMS).

The supermacy syndrom has spread across all in Armed Forces. Every single case generating from AFT involving retired & serving defence personnel is appealed in SC on filmsy grouds, sometimes to the extent that of "loss to national exchequer." Then SC finally passes strictures against Armed Forces for denying the just benefits to aggrieved petitioners. I mean this is absurd. It is time to come out of colonial hang over and educate to be more accountable. AFT is nothing short of RTI / SC in relation to Armed Forces.

Be it the case of bed ridden soldier where disability pension was denied whereas awarded 100% disability to Ex Army Chief for minor hearing problems, Permanent Women officers commission, MNS Officers case, and many other such cases should have not been apealed in SC in first place. It is pertinent to mention that in this context, separate Pay Commission for Armed Forces is not desirable.

The mindset has to change in respect of following: Transparency & accountability has to be brought in recruitment, promotions, Postings, Removal of disparity in Pay & Allowances, Check on corruption, Support services (AMC, MES, & others) meant for soldier has made the soldier slave. The recruit/Training process be redesigned to inculcate the inclusive welfare oriented values.

Anonymous said...

Navdeep Sir,

Can Army file an apeal in SC against the AFT Delhi Order on the the grounds of "Loss to National Exchequer" If so is the case, wasn't there a loss to national excheqer when PB-IV was granted to Lt Col general officers.

Can such apeals be treated as frivlous as mandated by NLP??

Col NR Kurup said...

Thank you Maj Navdeep for your wise analyse. While agreeing with you, my view is slightly towards the viewsof Anonymous.
Instead of weighing the status of orignator of the opinion viz., IAF or AIIMS the decision should have been based on the opinion itself. If the IAF Medical Board say a perticular person has heart murmur, and the AIIMS say that he does not have any murmor, that case itself should have put under scrutiny instead of catcvhing on the superiority of AIIMS or IAF.
Anyway I still feel that the IAF did not takethe issue seriously in the beginning Now the case is closed.

Anonymous said...

@ Col NR Kurup

IAF has taken the case seriously. Still these strictures will be passed because there is no logioc in the case. AFT recovered some money from those members of medical board in relation to a bed ridden soldier, where a member was Air Cmde even. So writing is on the wall. Be accopuntable & transparent otherwise, it brings a bad repute to whole armed forces. This is not specifically to AF but to all wings. AF is still more transparent than the other two. I brother was rejected by Naval authorities for heart murmur and subsequently Army authorities find no heart murmur and was selected. Heart murmur is indeed a subjective matter like raising Form 10, which is purely for some other reasons.

Aditya said...

Prima facie, it seems that justice has been done in this isolated case. However, with respect, I would disagre with the judgement of the honble apex court, if it implies that the opinion of a civil hospital overrides that of a military one. The question cannot be one of civil or military hospital, but of correctness of the diagnosis for the condition at hand. Furthermore, the observation of the honble high court suggesting that there can be no distinction in disease status between civil and military employment is clearly erroneous, if I may say so with all humility. Not having read the judgement, I will not comment on the facts of the case, but from what Maj Navdeep has posted, it appears that ld. counsel for the government seem to have erred in suggesting that what is not a disease in civil life becomes one in military life (which is absurd, and the honble court has commented upon the same). Rather, perhaps they should have argued that what is not a disqualification for employment in civil life, becomes one for employment in military life (which is entirely reasonable). IMO, a bad precedent has been set if civil hospital assurances can override those of defence hospitals on a matter of principle, rather than on the basis of clear and evident facts (although this case is clearly based on facts). A complex issue.

Anonymous said...

@Aditya

There is no question of agreement / disagreement. You must understand that once Apex court has said so.. it is final. I mean the very idea of disagreement or case not presented properly is absurd. We try to presume that we are above all, and can speak any thing in the banana republic. That is where the problem lies.

It is not basically Defence Vs Civil medical superiority but otherway round. If you have a dispute, you refer to apex authorities and that is AIIMS for medical related stuff. AF finds heart murmur to exists in a candidate and AIIMS finds no existence even. That means either existence or degree of heart murmur is too subjective or AF still using colonial methods to reject candidates on fancy grounds.

You must learn to accept the verdicts of Apex court. This is end of matter until AF files review petition.

Kaps said...

"The High Court observed that no medical text or journal had been brought to its notice that said that a person might not have a disease if he was looking for a civilian appointment, but that would become a disease when it came to military employment."

This also means that UOI is not clear about what medical standards it expects from the candidates applying for military appointments. I am actually surprised by this. Can some knowledgeable person please clarify?.

The mischief in this case is quite evident by vanishing of some disease and emergence of newer diseases as the case progressed. I hope UOI sticks to Mr Moily's suggestion and does not proceed with any further litigation.

Anonymous said...

Anon@7:48 I agree with most of your arguments and I have seen the arrogance and mulishness of the defence medical authorities all my life. But you are taking advantage of naive and uninformed comments of some of the members and are going on to preach things to the forces which is not required. And do citizens not express their opinion ( right or wrong) that they do not agree with the courts after the verdict is given. Every tom dick and harry goes blah blah publically saying the courts have been harsh or justice has not been done. So why cant someone say here he does not agree with the supreme court. Are they Gods?? And why this special restriction on the forces?? Are they your slaves or children or lesser God??

Anonymous said...

Just building further on my previous comments.
Nobody is rejected on basis of a heart murmur these days. An echocardiograph is essential which reveals the cause of the murmur. The medical standards for Flying and non-flying branches are there in black and white. The standards are available at http://careerairforce.nic.in/career_opp/caropp_officer_phystd.html

The criteria for appeal are also very clear. There are hundreds of candidates who are rejected every year.
As about heart murmurs, there are multiple causes for it. Some are of no significance to daily life routine but can be life threatening in the severe stress of military flying. There are hundreds of conditions for which candidates are rejected for Armed Forces whereas they are perfectly fit for normal civilian life. AIIMS doctors do not understand what is going to happen in those conditions and Air Force doctors do. Unfortunately, the court was probably not informed about this perspective. AIIMS doctors are very good at treating medical problems but that does not make them authorities at assessing medical fitness. There are hundreds of conditions which are normal variants for civilian population but can be catastrophic in real life conflict/military flying conditions.
Anyway, I hope this candidate survives the training and doesn't crash any planes jeopardizing precious lives.

medical specialist said...

FOR NCO LEVEL RECRUIT
only clinical exam is permitted and recruiting med offr refers suspected cases to medical specialist. The medical specialist bases on clinical exam only can accept or reject the case. it is a well known fact that even pulse > 120 min per min can cause systolic flow wmurmurs despite a structurally normal heart. even mild low haemoglobin of say 9-10 g/dL can produce some amount of systolic murmurs.
for NCO level entry lab test , ECHO and other investigations arent permitted.

FOR OFFICER LEVEL ENTRY
clinical exam is done and this in case of doubt can be evaluated with lab test, x ray, ECHO, or any other advance test avaiable to confirm or negate the finding.

In this judgement on med exam of recruit its not mentioned if it was for NCO level or OFFICER level.
since if it for NCO level only clinical evaluation by medical officer followed by med spl is permitted (NO ECHO IS ALLOWED)

Anonymous said...

@ Anon.. 6:49 PM

I need not to preach but please go through SC/AFT records and see for yourself. It is evident that until AFT came into existence, Armed Forces were being run on whims & whishes and the draconian way under the veil of secracy. Least respect for welfare, transparency and accountibility. 100% cases have gone against the forces in AFTs and in many cases dressing down by SC. So writings on the wall. It is not a case of anything else but supermacy syndrome "How I can be incorrect?" Sooner or later, we have to get out of this and accept that our actions have to be transparent, can be reviewed/overruled or even financial penalities imposed. I know it will take sometime.

Kumar said...

Just a little bit elucidation for non-medicos on this issue:"First, there was weight discrepancy and heart murmur. Then weight discrepancy vanished and hydrosil appeared along with murmur and lastly, hydrosil vanished within a day leaving behind systolic murmur."
1. Weight can be easily decreased/increased by 5-6 kg easily within a day. That's no rocket science.
2. Hydrocele can be tapped and will disappear for a few days, only to reappear after a few weeks.
3. Systolic murmurs can be functional or pathological. Echocardiography is required to assess these murmurs further. Only Stethoscope examination can be inaccurate and must not be the only tool available to make somebody unfit. That is why the "unfit" folks get the chance to see the specialists/superspecialists in the appeal medical board.
I was myself declared unfit for a murmur in my initial medical examination but was made fit by the cardiologist who found my murmur to be functional and not pathological. I haven't had any problems having been deployed up to 19 thousand feet in operational areas. Can't really find fault with the medical authorities for that.

I really don't know whether this candidate (?Recruit/officer/NCO level) went through the proper medical appeal procedure.

Anonymous said...

actually the system of rect needs to be changed and a more thorough med exam is reqd rather than cursory medicals done in field conditions as is done presently.only those candidates should undergo medical exam who have cleared all stages of rect. essential invs should form part of med exam and doctors to be held accountable for ommission or commission if any. the conditions in which rect medicals are done one can only sympathise with the poor doc and the candidates. a proper intelligence setup would also be reqd to curb any chances corruption taking place with exemplarry punishment for any wrongdoing.

docjoe said...

I am in complete agreement with Anonymous @ 16 Oct, 8.02 PM as regards the relevance of AF docs vs the AIIMS. HOWEVER, there has to be a forum of appeal, separate from the AF medical process, to opine on the fitness or otherwise of aspiring candidates, esp for the flying branch. I was a victim of the very absence of such a forum when I was invalidated for military flying way back in 1986 and it still rankles...Perhaps, the AF needs to update itself about the causative factors for aircrew medical deficiencies AS OBSERVED IN THE FIELD rather than kowtow to the ICAO standards (take a leaf out of the U.S.Air Force medical norms perhaps, most PRACTICAL...)

jitendra said...

plz mention Name of parties of this case with writ pettion number.because anyone use this citation in same type of case.

advppc said...

It would have been very nice if the details of the case like SLP No. and name of parties etc. are given. In case any one knows, kindly send me emial advppc1@gmail.com. Thanks in anticipation.

Roshni said...

Sir, I have gone through the contents of a Tribune dated 10.10.2010 in which you have uploaded observation and direction of the Hon'ble Supreme Court to the effect that the army authroity cannot overrule the findings of the civil hospital. In this regard, may I request you to let me know the actual text or citation of the said judgement, as the same is required for determination of a particular case pending before the High Court of Manipur, pliz send me mail on my mailing ID i.e. mroshnipiba@gmail.com

Anonymous said...

It would have been very nice if the details of the case like SLP No. and name of parties etc. are given. In case any one knows, kindly send me emial pawan.payal21@yahoo.in

Anonymous said...

@kumar

is a ventricular septal defect ( hole in the heart) considered a rejection for the indian armed forces?. It has been corrected through surgery , an echocardiogram shows up normal . Any response would be appreciated.