Kerala High Court
National Medical Educational ... vs Kerala Nursing And Midwifery Council on 6 December, 2005
Equivalent citations: 2006(2)KLT612
Author: K. Balakrishnan Nair
Bench: K. Balakrishnan Nair
JUDGMENT K. Balakrishnan Nair, J.
1. The petitioner trust has filed this Writ Petition, challenging the order of the 1st respondent Kerala Nurses and Midwives Council, declining to grant approval for its School of Nursing, for the academic year 2O05-06. The brief facts of the case, as stated by the petitioner, are the following :
2. The petitioner has obtained a No Objection Certificate from the Kerala Government, for establishing a Nursing School, as per Ext.P1 order dated 13.06.2005. It took a three storeyed rented building with a floor area of 14000 sq.ft. at Perumapadappa Panchayat in Malappuram district, for starting the Nursing school during this academic year itself. It has already purchased a plot of 7.04 acres in Thirumittakode Panchayat to construct the building to house the Nursing School. It has provided all requisite facilities like four class rooms, laborataries for Nursing Practice, Community Practice, Nutrition Laboratory, Audio Visual Aids, Fundamental and Anatomy Laboratories, rooms for the Principal and the Vice-Principal, Library, Reading room and Tutors' room etc., as per the norms of the Indian Nursing Council, in the said building. The petitioner moved the third respondent Indian Nursing Council for permission to start the Nursing School. The details of the facilities available, which were furnished before the Indian Nursing Council, are contained in Ext.P2. The petitioner has cited Santhi Nursing Home, Punnayurkulam, Arafa Hospital, Changaramkulam and K.V.M. Medical Centre, Perumpadappa, with 100 beds each and situated within a distance of 8 kms., as the parent/affiliated hospitals. The consent letters given by those hospitals are produced as Ext.P3 series. The 3rd respondent Indian Nursing Council made an inspection of the facilities provided by the petitioner and granted permission to it, for starting the General Nursing and Midwifery Programme, with an intake of 20 students. Ext.P4 is the communication issued by the Council to the petitioner. The Council simultaneously wrote to the State Government and to the 1st respondent, Kerala Nursing and Midwifery Council about the permission granted by it, to the petitioner. The permission contained in Ext.P5 was subject to the stipulation that the petitioner should get approval of the State Nursing Council and the Board. The Board mentioned therein, is the Examination Board. Pursuant to Ext.P5, the petitioner moved the 1st respondent for approval, for starting the Nursing School, during this academic year itself. The said respondent, after inspecting the facilities provided by the petitioner, issued Ext.P6 communication dated 28.10.2005, pointing out four deficiencies to be cured, for granting approval. Aggrieved by Ext.P6, the petitioner preferred Ext.P7 representation before the 1st respondent and along with that, Ext.P8 list of newly appointed staff and Head Nurses in the parent/affiliated hospitals, was also attached. The Nursing Council has fixed 30.11.2005 as the last date for admission to the Nursing Course, during this academic year. Therefore, aggrieved by Ext.P6, this Writ Petition is filed. According to the petitioner, Ext.P6 is ultra vires of the powers of the 1st respondent.
3. The petitioner has all the prescribed infra-structure and hospital facilities. Santhi Nursing Home is shown as the parent hospital. Therefore, the objection that there is no parent hospital for the petitioner, is not correct. Thirumittakode Panchayat, where the School building is going to be constructed, though, in Palakkad district, is a Panchayat, boardering Malappuram district. The distance between the present school and the new building is only 20 kms. The absence of an own building is not a deficiency, in terms of the provisions of the Indian Nursing Council Act, 1947, or the Regulations framed thereunder, for starting a Nursing School. The dearth of qualified teachers, has been taken care of, by making fresh appointments to those posts. Ext.P8 will prove the same. The physical and clinical facilities available in the Nursing School, are to be certified by the Indian Nursing Council. The State Nursing Council can lay down the guidelines and regulations, concerning academic matters only. On the above grounds, the petitioner seeks to quash Ext.P6 and prays for consequential reliefs.
4. The 1st respondent has filed a counter affidavit, resisting the prayers in the Writ Petition. As per Ext.P1, NOC was given to the petitioner, subject to the condition that it shall obtain approval from the State Nursing Council and the State Examination Board/University, to start the Nursing programme. As per the Regulations, an applicant for starting a Nursing School, should possess minimum four acres of land, to set up the proposed Nursing School. The applicant should own the building and rent arrangement is not acceptable. It is also submitted that the applicant should own and possess a parent hospital with 200 functional beds. Consent letters from private hospitals are not sufficient. Further, those hospitals are having only facilities for 100 beds each. When the Nursing School is shifted to the proposed site, those hospitals will be far away. Ext.P5 communication issued by the Indian Nursing Council is subject to the conditions regarding approval of the State Nursing Council and the Board and also subject to providing of facilities, as laid down by the Regulations of the Indian Nursing Council. The Inspection Commission of the 1st respondent, which inspected the petitioner's institution on 16.10.2005, found certain deficiencies. The State Council examined the said report and thereafter, issued Ext.P6 communication to the petitioner, calling upon it to rectify the deficiencies, enumerated therein. The petitioner has only rectified one of the deficiencies, i.e., regarding the appointment of qualified staff and that too, only partially. Therefore, it is submitted that the 1st respondent has rightly refused to grant approval for starting the Nursing School by the petitioner. Going by Ext.P7, it can be seen that the petitioner has failed to cure the deficiencies, pointed out by the Council in Ext.P6. The ownership/possession of the parent hospital has not, so far, been certified. The required number of new staff is yet to be appointed and no clarification has been given by the petitioner, regarding the problems that may arise on shifting the School to the new premises, from the present location, which is far away. Therefore, it is submitted that the petitioner is not entitled to start the Nursing School. The admissions for this academic year are closed on 30.10.2005. So, the first respondent prayed for dismissal of the Writ Petition.
5. The petitioner has filed a reply affidavit, denying the averments in the counter affidavit of the 1st respondent. It is submitted that the Indian Nursing Council Act, 1947, does not stipulate that permission to start a Nursing School can be granted, only to an applicant, who owns and possesses a hospital, with 200 functional beds. The policy of the 1st respondent, in this regard, is illegal, as the same is inconsistent with the guidelines, prescribed for establishing the Nursing School, by the Indian Nursing Council. The 1st respondent cannot introduce any stipulations, over and above, that are prescribed by the Indian Nursing Council. 200 bedded parent hospital need not be in the possession/ownership of the Nursing School. The parent/affiliated hospitals of the petitioner taken together, have 300 functional beds. It is also submitted that even if the petitioner shifts to the new building, which is being constructed by it, still, the arrangement with the existing hospitals will be continued, as they are available within a reasonable distance. The allegation that the petitioner did not fully comply with the stipulations regarding Nursing staff, is denied by the petitioner. Time, in this case, has run out because of the delay from the part of the 1st respondent, to take a decision in the matter. Therefore, the petitioner submits, its claim cannot be defeated, raising the plea of delay. Therefore, the petitioner prays for allowing the Writ Petition.
6. The 3rd respondent has filed a statement. In the said statement, it is stated among other things, that for an intake capacity of 20 students, the constructed area of the school should be 4000 sq.ft. For every additional 10 seats, an additional constructed area of 2000 sq.ft. should be added. Concerning clinical facilities, the Regulations stipulate that the School of Nursing should have a 200 bedded parent/affiliated hospital. Based on the recommendation of the Inspection team, it is submitted that Ext.P5 decision has been taken in favour of the petitioner.
7. I heard learned Senior Counsel Mr. M.K. Damodaran for the petitioner. Shri. N. Raghuraj, learned Standing Counsel for the first respondent, Mr. Noushad Thottathil, Standing Counsel for the 3rd respondent and also Mr. George Mecheril, learned Senior Government Pleader, for the 4th respondent. The learned Senior Counsel for the petitioner submitted that the deficiencies noticed in Ext.P6, except the one, concerning teaching staff, are non existing and therefore, they cannot be pressed into service, to reject approval. It is also submitted that going by the scheme of the Indian Nursing Council Act, the same occupies the field, concerning infra-structure facilities to be provided in a Nursing School. So, the provisions in the Travancore Cochin Nurses and Midwives Act, which enable the State Council to consider on the availability of infra-structure facilities, are repugnant to the provisions of the Central Act and therefore, unenforceable. Going by the scheme of the above said two Acts, the field concerning academic matters such as prescribing syllabus, method of instruction, holding of examination etc., alone are left unoccupied by the Central enactment. So, the State Council can exercise powers, only in relation to these matters. So, once the Indian Nursing Council is satisfied, regarding the infra-structure facilities, the State Council cannot reject approval, on the ground that the School does not have the requisite infrastructure facilities. In support of the above contentions, reliance is placed on the decisions of the Apex Court in Jaya Gokul Educational Trust v. Commissioner and Secretary to Government 2000(2) KLT SC 267, Thirumuruga Kirupananda V.T.S.S.M.E. & C. Trust v. State of Tamil Nadu and State of Tamil Nadu v. Adhiyaman Educational and Research Institute .
8. The learned Counsel for the 1st respondent submitted that the physical facilities available in a Nursing School are to be verified by the State Council. Section 26 of the Travancore Nurses and Midwives Act, 1953 and Rules 83 and 84 of the Kerala Nurses and Midwives Rules, enable the State Council to recognise and approve Nursing Institutions. According to the learned Counsel, going by Sections 10 to 14 of the Indian Nursing Council Act 1947, the said Act mainly governs matters, relating to recognition of qualifications. The said Act is not meant to occupy the entire field of Nursing Education. It is also pointed out that there is no conflict between the provisions contained in the State and the Central Acts. So, the contention regarding repugnancy is unsustainable, it is submitted.
9. Before dealing with the rival contentions. I think, it is fruitful to refer to the relevant provisions of the Indian Nursing Council Act and the Travancore Cochin Nurses and Midwives Act. The statement of objects and reasons of the Indian Nursing Council Act, 1947 reads as follows :
Provincial Nursing Councils have been established in all Provinces and maintain registers of qualified nurses, health visitors and midwives. Increasing difficulties have been experienced by the Nursing profession and by employing authorities owing to the diversity in the standards of preliminary education of candidates, entering training schools of nursing, the varying standards of training and examination for nursing certificates and the lack of inter provincial reciprocity in the registration of nurses. To remedy these difficulties, it is proposed to enact legislation for the purpose of setting up an Indian Nursing Council, which will prescribe uniform minimum standards of education and training for nurses, midwives and health visitors, supervise examinations and maintain a schedule of qualifications recognised for registration throughout India. To avoid delay, an Ordinance was passed in August 1947 for this purpose. The Ordinance will be repealed by this Act.
The preamble of the Act says that it is passed, in order to establish a uniform standard of training for Nurses, Midwives and Health Visitors. Section 2 contains the definitions. Section 2(a) defines the Council as the Council, constituted under the Act. Section 2(c) defines the State, Council as a Council, by whatever name called, constituted under the law of a State, to regulate the registration of Nurses, Midwives or Health Visitors in the State. Section 3 deals with the constitution of the Council. Section 4 says, the Council shall be a body corporate, having perpetual succession. Section 5 provides the method of election to the Council. Section 6 deals with term of office of the Council and casual vacancies. Section 7 deals with meetings and their quorum. Section 8 deals with Officers and servants of the Council apart from the committees. Section 9 provides for the constitution of an Executive Committee. Section 10 deals with recognition of qualifications. Sub-section (1) thereof provides that the qualifications included in Part I of the Schedule of the Act shall be recognised qualifications and those included in Part II of the Schedule shall be recognised higher qualifications. Sub-section (2) of Section 10 says, if a particular State awards a qualification in General Nursing, Midwifery etc., which is not included in the schedule of the Act, it may apply to the Central Council, to have such qualification recognised. So, the Central Council is vested with the jurisdiction to recognise qualifications for the purpose of registration as a Nurse, which is not included in the schedule of the Act. Section 11 deals with the effect of recognition. A recognised qualification shall be sufficient for enrolment in any State register of Nurses. After the commencement of this Act, no person shall be enrolled in any State Register, unless he holds a recognised qualification. Section 12 provides that every Authority in any State, which grants a recognised qualification, or a higher qualification, shall furnish such information, as the Central Council may, from time to me, require, as to the courses of study, training and examinations to be undergone in order to obtain such qualifications etc. Section 13 enables the Executive Committee of the Central Council to appoint Inspectors to inspect any institution, recognised as a training institution and to attend examinations held for the purpose of granting any recognised qualification or recognised higher qualification. They are authorised to report regarding the suitability of the institution for the purpose of training, adequacy of the training therein and also on the sufficiency of the examinations. The Executive Committee, shall forward the copy of the reports so obtained, to the institution concerned and to the Central Government, State Government and the State Council of the State, in which the institution is situated. Section 14 deals with the withdrawal of recognition of a qualification. Since both sides relied on the said section, in support of their submissions, it is quoted below for convenient reference :
Withdrawal of recognition --
(1) When upon report by the Executive Committee, it appears to the council -
(a) that the courses of study and training and the examinations to be gone through in order to obtain a recognised qualification from any authority in any State or the conditions for admission to such courses or the standards of proficiency required from the candidates at such examinations are not in conformity with the regulations made under the Act or fall short of the standards required thereby, or
(b) that an institution recognised by a State Council for the training of nurses, midwives or health visitors does not satisfy the requirements of the Council the Council may send to the Government of the State, in which the authority or institution, as the case may be, is situated, a statement to such effect and the State Government shall forward it along with such remarks as it may think fit, to the authority or institution concerned and in a case referred to in Clause (b) to the State Council also, with an intimation of the period within which the authority or institution may submit its explanation to the State Government.
(2) On the receipt of the explanation or where no explanation is submitted within the period, the State Government shall make its recommendations to the council, (3) The Council, after such further inquiry, if any, as it may think fit to make and in a case referred to in Clause (b) of Sub-section (1), after considering any remarks which the State council may have addressed to it, may declare -
(a) in a case referred to in Clause (a) of that Sub-section , that the qualifications granted by the authority concerned shall be recognised qualifications only when granted before a specified date or
(b) in a case referred to in the said Clause (b) that with effect from a date specified in the declaration, any person holding a recognised qualification whose period of training and study preparatory to the grant to him of the qualification was passed at the institution concerned, shall be entitled to be registered only in the State in which the institution is situated.
(4) The Council may declare that any recognised qualification granted outside the States shall be a recognised qualification only if granted before a specified date.
From the above quoted provision, it can be seen that the Executive Committee has powers to deal with the qualifications obtained by the persons from two types of institutions. If the course of study, training and examinations to obtain a recognised qualification from any authority in any State are not upto the mark in terms of the Regulations framed under the Act, the Executive Committee, after hearing the views of all concerned, order that the qualifications granted by that authority only upto a particular date, shall be recognised. That means, from a particular date, the said qualification will not be sufficient to get registration. It also provides that if the training imparted in an institution, recognised by the State Council, does not satisfy the requirements of the Central Council, the Executive Committee, after hearing all parties concerned, order that a person, who got the recognised qualification from that institution after a particular date, is entitled to be enrolled only in the register of that particular State. In other words, the qualification obtained after a particular date, from the said institution, shall be de-recognised for the purpose of enrolment in the register of other States. Section 15 deals with the mode of declaration, concerning recognition of qualification under Section 10 and de-recognition of qualification under Section 14. Section 15A deals with Indian Nurses Register. Section 15B deals with supply of copies of State Registers. Section 16 deals with the Regulation making power of the Central Council. Section 16(1)(d) enables the Council to prescribe the functions of the Executive Committee and Section 16(1)(e) enables to prescribe standard curricula for the training of Nurses, Midwives and Health Visitors, for training courses for teachers of Nurses, Midwives and Health Visitors and for training in Nursing Administration.
10. Going by the above mentioned provisions of the Act, I feel that the Act does not empower the Central Council to deal with recognition or approval of institutions, imparting education in Nursing. The function of the Central Council, is mainly concerned with the recognition of qualifications, for the purpose of enrolment in the State Register. It also enables the Central Council, to de-recognise any recognised qualification awarded by any authority in view of the provisions contained in Clause (a) of Sub-section (1) of Section 14 read with Clause (a) of Sub-section (3) thereof. In the case of institutions, like the institution of the petitioner, the power of the Central Council in the light of Clause (b) of Sub-section (1) of Section 14 read with Clause (b) of Sub-section (3) thereof, is limited to de-recognising the qualification obtained from such institutions in other States. Even after the disapproval of the Central Council, the said qualification remains valid for the parent State. Recognition or de-recognition of institutions, like that of the petitioner, imparting training in nursing, does not come under the purview of the Indian Nursing Council Act. 1947. But, the power to recognise the qualifications, may confer incidental or ancillary power to prescribe the minimum facilities to be provided for, in the Nursing institutions. So, by virtue of the regulation making power contained in Section 16(1) of the above said Act, the Central Council may prescribe the physical and clinical facilities that may be provided in an institution. The same is only for the purpose of deciding whether the training imparted in that institution, is upto the mark to enjoy the recognition for the qualification awarded pursuant to the training. Recognition or approval of institutions is essentially the function of the State Nursing Council. Section 14(1)(b) of the Act also recognises the said position.
11. In Section 28 of the Travancore Cochin Nurses and Midwives Act, an express provision is made for approval of institutions by the State Nursing Council. Section 26 of the said Act reads as follows :
Institution for training and midwives:
(1) The institutions which are approved and recognised by the Council after inspection by its representative shall be competent to train nurses and midwives, auxiliary nurses, midwives and health visitors and send them for examination for the qualifying certificates recognised by the Council.
(2) The Council may withdraw recognition from any such institution, after its inspection, by a representative of the Council. The order of such withdrawal shall be in writing and shall be served in the manner prescribed by rules.
Section 36(c) authorises the State Nursing Council to frame regulations for approval of institutions, imparting training in Nursing. Rules 83 and 84 of the Kerala Nurses and Midwives Rules deal with recognition of institutions and withdrawal of approval and recognition of institutions. They are quoted below for convenient reference-:
83. (1) The Council shall from time to time, approve and recognise institutions which in its opinion, are competent to train, nurses, midwives, auxiliary nurses, and health visitors and to grant degrees, diplomas or certificates to them for the purpose of admission to the register under these rules and report the fact to the Government.
(2) For purposes of recognition of a training institution under Sub-rule (1), the institutions should satisfy the conditions specified in the regulations made by the council under Section 36 for training and examination of nurses, midwives, auxiliary nurses and health visitors.
(3) Every training institution shall provide full facilities for inspection by the representative of the Council if and when so directed by the Council.
(4) Every training institution that seeks recognition by the Council shall furnish in advance, a sum of one hundred rupees per member of the Inspection Commission for every inspection. This amount shall be remitted to the Registrar in cash before sending of such commission.
84. If on the report of its representative, the Council is of opinion that the training in an approved and recognised institution is not being properly carried on or that the authorities or the institutions have not carried out the directions and suggestions, if any, of the Council or in the opinion of the Council, the institution is not fit to be continued as a recognised one, the Council may withdraw its recognition and report the fact to the Government. Such institution shall not be approved and recognised again, unless and until the Council is satisfied that the training at such institution will be properly carried on in future. The order of withdrawal shall be served by registered post.
12. In view of the above position, the contention of the learned Senior Counsel for the petitioner that in the matter of approval of an institution, the State Council has no role, cannot be accepted. But, in fact, going by the scheme of the Central and State Acts, the power/authority to approve/recognise an institution is essentially conferred on the State Council. Since the legislations occupy different fields, there is no question of any repugnancy. So, the contention of the learned Senior Counsel for the petitioner that the field is already occupied by a central legislation and therefore, Section 26 of the State Act and Rules 83 and 84 of the Rules, framed thereunder, concerning recognition/ approval of a Nursing institution, are void, cannot be accepted. So, the decisions cited by the learned Senior Counsel for the petitioner do not have any application to the facts of this case.
13. The next point to be considered is on the dispute whether the petitioner's institution has all the facilities in conformity with the Regulations, framed by the Central Council. The Central regulation concerning permission, for the establishment of an institution for imparting training in Nursing, provides as follows:
The Authority, which desires to open a School of Nursing, has to furnish the following documentary proof to the Indian Nursing Council and comply with the following :
1. An organisation (private, trust, mission, voluntary etc., registered under Society Act) to open a School of Nursing, should obtain the no-objection certificate from the State Government.
2. The Indian Nursing Council on receipt of no objection certificate from the organization will undertake first inspection to assess suitability to start the programme.
3. On the assessment of INC, if the institution is found suitable to start the programme. INC shall write to the State Nursing Council/Board for inspection.
4. On receipt of the inspection report from the State Nursing Council/Board, INC shall decide whether to give permission to admit the students or not.
5. The Indian Nursing Council will conduct inspection every year till the first batch is passed out.
The physical facilities to be provided for starting a Nursing School, are detailed in the Regulations. The provision, concerning Building, reads as follows:
The School of Nursing should have a separate building. If the School is situated in hospital premises, the area marked for the building of the school should be at a suitable distance from hospital which enables a calm environment ideally required for a school. Minimum land area recommended by INC for a School of Nursing is four acres of land owned and possessed by the applicant to set up the proposed nursing school. For a school with an annual admission capacity of 20 students, the constructed area of the school should be 4000 sq.ft. For every additional 10 seats, an additional constructed area of 2000 sq.ft. should be increased. Constructed area can be increased in phased manner between first and second year.
The provision, concerning clinical facilities deals with the requirement, concerning Hospital, which reads as follows :
Hospital:
1. There must be a parent hospital for providing practical experience to the students.
2 The parent hospital should have a minimum of 200 functional beds with a daily average of not less than 75% occupancy for an admission of 20 students per year. There should be outpatient departments, casualty department, operating rooms, central sterile supply department and incinerator in the hospital.
3. The parent hospital should provide the clinical learning experiences required for the students in the areas of Medical, Surgical, Pediatric, Eye, ENT, Maternity, Gynaecology and Orthopaedic Nursing.
4. There should be a variety of patients of all age groups in all the clinical areas where the students are posted for obtaining the requisite learning experiences.
The above quoted are the provisions of the Regulations, relied on by the petitioner. The learned Counsel for the 3rd respondent also supports that the above quoted requirements alone are necessary for starting a Nursing School. But, the learned Counsel for the 1st respondent submitted that recently, the Indian Nursing Council has amended the above Regulations on 30.04.2005 and the present stipulation regarding Building, reads as follows:
Building-School/College of Nursing Building:
a) Running the nursing educational institution in rented building affects quality in nursing education programme. It is therefore, compulsory that nursing programmes should be started in their own building. Institutions, which are functioning in rented building, should ensure within the period of 2 years, they should construct their own building.
b) Minimum 3 acres of land is required to start nursing school/college subject to the conditions that they have minimum 54470 sq.ft. constructed area.
There is some dispute regarding the Regulations, which are now applicable to the Building and Hospital. I feel that the above dispute may not be of much consequence, in view of the fact that the petitioner can run the institution, only after getting the approval of the State Council. The Regulations framed by the Central Nursing Council cannot have the efficacy to obliterate Section 26 of the Kerala Act, which is a plenary legislation of the State Legislature. Ext.Pl N.O.C. has been granted to the petitioner, subject to the following conditions :
1) Before starting the course, the institutions/organisations shall obtain permission from the Indian Nursing Council. The Indian Nursing Council accords permission after undertaking the first inspection to assess suitability with regard to physical infrastructure, clinical facility and teaching faculty to start the programme.
2) The institution shall obtain the approval from the State Nursing Council and Examination Board/University to start the nursing programme.
3) Institution will admit the students, only after taking approval of State Nursing Council and Examination Board/University.
4) The Indian Nursing Council will conduct inspection every year till the first batch completes the programme. Permission will be given year by year till the first batch completes.
Condition Nos.2 and 3 quoted above, are not satisfied in the case of the petitioner. Ext.P5 also provides that the permission is granted, subject to approval of the State Nursing Council and the Examination Board. So, the contention of the petitioner that once the Central Council has permitted the opening of the Nursing School, the State Council cannot insist for any further condition, concerning physical facilities or clinical facilities, cannot be accepted. Since the State Council is the approving authority, it can insist that in certain matters, the facilities should be something more than the minimum, that is prescribed under the Central Regulations. But, in this case, the said situation does not arise. The State Council only says, the facilities as per the Central Regulation, as understood by it, should be available. The insistence of the State Council that a mere consent letter of the parent hospital will not be sufficient and the parent hospital should have a bed strength of 200, cannot be brushed aside as irrelevant. It is true, the petitioner produced a consent letter from Santhi Nursing Home to function as its parent hospital. The said consent letter can be withdrawn by the Management of that Hospital, at any time. In that event, the students will be left in the lurch. So, there is force in the contention of the State Council that the applicant should have ownership or at least, possession of the parent hospital as a lessee. If the State Council declines to act on the mere consent letter of the parent hospital, the same cannot be said to be illegal or irrational. The conditions imposed in Ext.P6, for approval of the Nursing institutions, cannot be said to be arbitrary or unwarranted. They are necessary for the running of a Nursing School. The permission granted by the Central Council is only a preliminary step in the establishment of a Nursing School. The same can only guarantee that a person, who passes out from the institution, can get enrolment in other States also, going by Section 14 of the Indian Nursing Council Act. Without getting the approval of the State Council and also the State Examination Board, the petitioner cannot admit any students. In view of the paramount position of the State Council in the matter of approval of a Nursing School under the statutory scheme, the contentions raised by the petitioner against Ext.P6 cannot be accepted. Therefore, the challenge against Ext.P6 is repelled. The petitioner may comply with the stipulations contained in Ext.P6 and move the State Council for approval. In that event, the State Council shall inspect the petitioner's institution and take a decision on the motion made by it for recognition of its Nursing School. Subject to the above observation, the Writ Petition is dismissed.