Kasaragod: On New Year's Day this year, the Kerala government pulled off what it thought was a masterstroke: it gifted Kasaragod a medical college hospital -- not by building one, but through paperwork.

On December 31, 2024, the Department of Health and Family Welfare, through a government order, decreed that "the General Hospital, Kasaragod, will henceforth be known as Government Medical College Hospital, Kasaragod". And just like that, the next morning, under the giant arch of the General Hospital, officials propped up a tiny, unconvincing board that read: Medical College Hospital, Kasaragod.

This bureaucratic sleight of hand was meant to prepare a teaching hospital so the state could finally admit 50 MBBS students in Kasaragod Medical College in the 2025-2026 academic year.

Eight months later, reality has caught up. The national NEET UG counselling is already in Round 2 and will wrap up by mid-September, but Kasaragod Medical College is nowhere on the list of colleges to choose from.

Yet, the government clings to optimism. "We are still hoping NMC will give us permission to begin admission this year," said Dr Premaletha T K, Special Officer for New Medical Colleges at the Directorate of Medical Education.

The National Medical Commission (NMC), the apex body regulating medical education and practice in India, conducted a virtual inspection of the renamed General Hospital in Kasaragod town and the medical college campus at Ukkinadka, 10 km from the Karnataka border, on July 1.

"The NMC was happy with our arrangement. But the distance between the teaching hospital and the medical college campus could be a hurdle," Dr Premaletha said. "But during the inspection, they did not say anything adverse."

A far stretch
Under the NMC’s 2023 regulations, if the teaching hospital is on a separate campus, it must be reachable from the academic block within 30 minutes -- a relaxation from the previous 10 km rule.

Kasaragod's General Hospital is 27 km from the Ukkinadka campus in Badiadka panchayat, and the ride takes around 50 to 55 minutes. "Even an ambulance cannot cover that distance in 30 minutes," said K K Ashokan, health activist and secretary of the Confederation of Endosulfan Victims Rights Collectives (CERV Collectives). Instead of finishing the hospital block, abandoned since 2022, the government seems to think a new name board is enough to fool the NMC, he said.

What people mean by medical college
When people in Kasaragod demand a medical college or an AIIMS, what they actually mean is access to tertiary healthcare or a superspeciality hospital, said Prasad Maniyani, convenor of the North Malabar Chamber of Commerce, Kasaragod Chapter.

"That's common man's lingo. The government's priority should be to establish a fully functional tertiary care hospital for the people of Kasaragod first, instead of bending rules and exploiting loopholes merely to admit 50 MBBS students, which, for better or worse, is not working out either," he said.

Kasaragod remains the only district in Kerala without tertiary health care. For life-threatening conditions, residents are forced to turn to expensive private speciality hospitals and medical colleges in neighbouring Mangaluru.

Dr Premaletha said that the medical college hospital block would take another three years to complete. "The first batch would need a teaching hospital only by then," she said, confirming Maniyani's charge of misplaced priorities.

Technically, she is correct as the first two years are dedicated to pre-clinical and para-clinical subjects such as Anatomy, Physiology, Biochemistry, Pharmacology, Pathology and Microbiology. But the NMC's three-year rule for teaching hospitals is a safeguard for quality education.

A hospital takes time to mature: to build patient load, stabilise ICUs and operating theatres, and recruit specialists across departments. The rule ensures that when the first batch steps into clinical postings, they are not met with fledgling wards.

Besides, early clinical exposure is now built into the MBBS curriculum from day one, making a fully functioning -- and accessible -- teaching hospital indispensable from the start.

Only 12 of 21 departments exist
Under the 2023 NMC regulations, a medical college with 50 intake must have at least 21 departments, staffed with 14 professors, 20 associate professors, 25 assistant professors, 15 tutors, and 23 senior residents.

An official at the General Hospital said that only 12 of the required departments are functional: General Medicine, Paediatrics, Psychiatry, General Surgery, Orthopaedics, ENT, Ophthalmology, Obstetrics and Gynaecology, Anaesthesiology, Radio-Diagnosis, Dentistry, and Dermatology.

The missing departments are Anatomy, Physiology, Biochemistry, Pharmacology, Pathology, Microbiology, Forensic Medicine and Toxicology, Community Medicine, and Integrative Medical Research -- all mandatory.

Still, the government insists these departments and appointments will be put in place in a jiffy once the NMC issues the Letter of Permission, a classic Catch-22 that keeps the project stuck.

No hostel, no library either
As per NMC norms, a medical college must provide hostels for students, interns, and staff. In August 2022, Health Minister Veena George laid the foundation for the women’s hostel and staff quarters, awarding the contract to ULCCS. The building now stands, but without electrical wiring. The men's hostel hasn't even broken ground.

The Ukkinadka campus also lacks an anatomy museum and a library, both basic, mandatory requirements. Health activist Ashokan pointed out that without hostels, the college cannot function, as the campus is so remote that there are no nearby buildings to rent for students or staff. "If the NMC grants permission to admit students, it won't be a medical college... it will be a medical miracle," he said.

Status of medical college
Nearly 12 years ago, in November 2013, then chief minister Oommen Chandy laid the foundation stone for the Kasaragod Medical College at Ukkinadka. That same year, Union HRD Minister M Pallam Raju laid the foundation stone for the Central University of Kerala's permanent campus at Periya, 40 km from Ukkinadka, in Kasaragod district.

By 2018, CUK had shifted to the Periya campus, built eight hostels, multi-storey staff quarters, and set up 26 departments. Since then, 6,100 students, including PhD scholars, have graduated, and today around 2,500 students study there.

By contrast, the Ukkinadka campus lies abandoned, a ghost campus. The government runs a token outpatient consultation from the academic block. Work on the hospital block stopped in 2022 after the government failed to clear the bills of the Erode-based contractor, RR Thulasi Builders.

"The building stands, but without electrical wiring. The company, awarded a  ₹95-crore contract, completed  ₹49 crore worth of work before taking the state government to court," said Mahin Kelot, IUML leader and president of Kasaragod Medical College people's committee. Even after three years of litigation, the government still owes about  ₹5.5 crore. On July 3, 2023, it told the High Court that it would clear the dues in two weeks.

The state has since re-estimated the unfinished work and handed it to its go-to contractor, ULCCS (Uralungal). But without an NOC from RR Thulasi, ULCCS has not moved in. The Directorate of Medical Education admits it will take at least three more years to finish the hospital.

If the NMC rejects Kasaragod's application over the teaching hospital's distance, the blow will be even harsher: there is no other 220-bed hospital in the vicinity to fall back on, said Dr Premaletha.