Seventeen years after an Act was introduced to provide equal opportunities to the disabled, inconsistency continues to plague the process of evaluating just how much a person is disabled. Disability is today expressed in percentage terms but a uniform system of certification eludes the country.
A candidate whose locomotive disability was certified at 40 per cent by the Darbhanga Medical College, authorised for this purpose by the Bihar government, ranked 113 in IIT-JEE this year under the general physically handicapped category. Yet, during counselling, he was found unfit for admission because a medical board comprising AIIMS doctors ruled his disability was only 23 per cent.
In 2003, an MBBS student diagnosed with a locomotive disability was denied admission by Delhi University to a postgraduate course, his certificate from the state government's Lok Nayak Hospital notwithstanding. And in 2007, a partially blind student of Delhi University was denied a writer to assist her in exams, though a state government certificate had put her vision loss at 50 per cent.
At the centre of such disputes are candidates who, eyeing the 3 per cent reservation under the Disability Act, invariably have certificates from state medical colleges but then find these rejected by boards appointed by central institutes.
This year, Delhi University abolished its medical board and declared that a certificate from any government medical college would do. Dr Bipin Tiwary, dean of students' welfare in DU's wing for the physically handicapped, says, "A question we raised was that being a government university, how can we doubt the integrity of certificates issued by our own government hospitals? This double examination causes undue harassment for students."
But the IITs and the IIMs, the UPSC, AIPMT, AIIMS, JIPMER, and JNU all insist on a double check. "If we can sit for the entrance on the basis of our existing certificate, why do we need to go through an examination by a separate board after we qualify in the same entrance?" says Amit Kumar, the IIT aspirant who lost out this year. IIT authorities say their rules are advertised beforehand. "If the candidate had a problem with the rules, he should not have applied, or should have protested earlier," says Dr G B Reddy, IIT-JEE chairperson.
Right to certify
In 2002, the Delhi High Court observed that though the Persons with Disabilities Act, 1995, stipulates that a medical board specified by notifications will be authorised to issue disability certificates, no such notifications had been passed till then. This was after a petition by an NGO. "For the last more than six years, it did not occur to the authorities that the basic requirement is to specify such medical authorities by means of a notification," the court observed.
The court identified nine government hospitals in Delhi; this was followed by a Central directive that government hospitals across the country would be authorised to issue such certificates. But a survey in 2010 found barely 35 per cent of the disabled had managed a certificate.
In December 2009, the Act was amended and fresh guidelines issued, aimed at decentralising the procedure. On paper, the issuing authority was changed from a medical "board" to an "authority". A list of central government hospitals was notified to issue certifications for three kinds of disabilities — locomotive, visual and hearing. A tiered system was created under which "obvious" disabilities could be certified by even primary and community health centres; "non-obvious" disabilities examined by a single specialist; multiple disabilities checked by a board set up for that. Three years on, no hospital among AIIMS, Safdarjung, PGI Chandigarh and JIPMER has made a single-specialist decision. Doctors say a board helps reach "consensus" in a dispute.
The amendment also saw the first official guidelines being released for expressing disability in percentages. It set a deadline for issuing a certificate — between a week and a month of request — but at AIIMS, say, the waiting list runs into months. Besides, the objective of decentralisation is defeated by the fact that no state other than Gujarat, Bihar, Goa and Tamil Nadu has notified the new rules.
Says Dr Anoop Raj, head of the ENT department at Maulana Azad Medical College associated with Lok Nayak Hospital, "Now we have formed a general rule in our department. We don't let our doctors consult past certificates of candidates, because we found they were getting influenced."
In ENT, doctors say they do audiometry tests if loss of hearing is obvious, a speech test if there is any room for doubt, and a brain response system for evaluation. "A district hospital will have an audiometry test but not the more advanced tests. These are the problems that create differences," Dr Raj says.
Dr Nonica Laisram, head of physical medicine and rehabilitation at Safdarjung Hospital, insists the 2009 guidelines are specific. "When other states follow their own rules, it creates disputes. We do not have this problem within our department, but we usually give certificates only to patients who have been treated in our OPD, except in medico-legal cases."
And, says JNU's dean of students' welfare Prof Abdul Nassey, "Different states still follow different rules, even though all certifications are from government hospitals. The medical officer in our health centre evaluates these candidates again, to factor in these variations and take the final decision."
The tests are standard in visual disability, for instance. However, says AIIMS's opthalmology head Dr R V Azad, "It depends on how the doctor factors in small margins, say the difference between 6/16 and 6/18. If small centres do not have the facilities for all tests, they may be doing their own thing... We have so many rules. We have the WHO rules for certifying blindness, we have our own rules under the National Blindness Control Programme, and we have a completely different set of guidelines from the Ministry of Social Justice and Empowerment for certifying disability."
Reena Bhatia, who was denied a writer by DU in 2007, says, "On the one hand we are told that even primary health centres are authorised. But I had a certificate from a state medical college, and even that did not satisfy the university."
Doctors from states accuse the Centre of a "hedonistic attitude". "When our institute, which has government authorisation, says the student is disabled, what right has the IIT to subject him to a second examination, and actually counter our claims?" says Dr Suraj Nayak, medical superintendent at Darbhanga Medical College. "We follow all standard guidelines." AIIMS doctors who examined Amit Kumar felt his condition could have improved through surgery.
A Delhi High Court judgment in 2003 had certified that the decision of a government medical college would be binding and always override boards set up by institutions. "On a conjoint reading of Section 58 of the Disabilities Act and Rule 4 of the Disability Rules, it will be crystal clear that individual universities, institutions or establishments have no alternative but to accept a certificate issued by the medical boards constituted by the governments," the court had observed.
University authorities say they double check for fear that the disability clause has been misused. Yet, as Dr Tiwary of DU points out, "Such misuse is possible in all reservations. We have so many cases of fake caste certificates being generated... Viewing the disabled with this suspicion is not justified."