‘Rural health practitioners are not medical practitioners’; Assam Rural Health Regulatory Authority Act, 2004 rightly struck down by Gauhati HC: Supreme Court

Supreme Court: The bench of BR Gavai and BV Nagarathna*, JJ has held that the Assam Rural Health Regulatory Authority Act, 2004 that permitted Diploma holders to practise ‘medicine’, i.e., allopathic medicine, in rural areas of Assam, is null and void and has been rightly struck down by the Gauhati High Court. The Court has, however, held that the Assam Community Professional (Registration and Competency) Act, 2015, which was enacted by the State of Assam with a view to remove the basis of the impugned judgment of the Gauhati High Court, to restore the position of the diploma holders in medicine and to give them continuity in service, is a valid piece of legislation.

Controversy

The controversy revolved around the legislative competence of the Assam State Legislature to enact the Assam Rural Health Regulatory Authority Act, 2004 (the Assam Act) which had been assailed by the writ petitioners before the Gauhati High Court on the ground of legislative competence as per Article 246 read with the relevant entries of List I and III of the Seventh Schedule of the Constitution of India. The Gauhati High Court struck down the Assam Act on the ground of repugnancy as per Article 254 of the Constitution.

Issues

i) Whether the Assam Act is invalid and null and void on the ground that the Assam State Legislature did not possess legislative competence to enact the said Act?

ii) Whether the Assam Community Professional (Registration and Competency) Act, 2015, which was enacted with a view to remove the basis of the impugned judgment of the Gauhati High Court and to restore the position of the diploma holders in medicine and to give them continuity in service, is ultra vires the Constitution?

Analysis

Who can practise medicine?

Going through the scheme of the Indian Medical Council Act, 1956 vis-à-vis the Assam Act, the Court observed that allopathic medicine, which is governed by the Central Act, cannot be practised by persons who do not possess the qualifications contemplated under the Schedules to the Central Act. As the practice in modern scientific medicine including allopathic medicine, is governed by the Central Act, in order to be recognised as a practitioner in any branch of modern scientific medicine, including allopathic medicine, the qualifications that must mandatorily be obtained are those listed in the Schedules to the Central Act.

The Court also took note of the fact that the Assam Act permits Diploma holders to practise ‘medicine‘, i.e., allopathic medicine, in rural areas of Assam. Further, the Rural Health Practitioners possessing a Diploma under the Assam Act have been authorised to perform certain functions identical to those performed by medical practitioners who possess qualifications prescribed under the Central Act. Such functions include treatment of common illnesses, prescription of certain categories of drugs, performance of minor surgeries, issuance of illness and death certificates.

Observing that performance of such functions by persons who do not possess the qualifications prescribed under the Central Act, could have dangerous consequences, the Court held that Rural Health Practitioners enlisted under the Assam Act, are underqualified to perform functions like those performed by medical practitioners registered in accordance with the Central Act.

Legislative Competence to enact the Assam Act

The State Legislatures, under Entry 25 of List III, possess legislative competence to legislate with respect to all other aspects of education, except the determination of minimum standards and co-ordination. With a view to provide a benchmark quality of medical education, it is essential that uniform standards be laid down by the Parliament, which are to be adhered to by institutions and medical colleges across the country. To this end, Entry 66 of List I has been formulated with the objective of maintaining uniform standards of education in fields of research, higher education, and technical education. Hence, State Legislatures lack legislative competence in the areas of prescription of minimum standards for medical education, authority to recognise or de-recognise an institution, etc.

However, the Assam Act, which is enacted by the State Legislature on the strength of Entry 25 of List III, not only seeks to introduce a new course in the field of medical education, but also seeks to regulate the profession of the candidates successfully completing the said course. It vests with the Regulatory Authority constituted thereunder, the power to prescribe the minimum standards of the course, duration of the course in allopathic medicine the curriculum, the examination etc. Further, it authorises the State Government to grant permission for the opening of a medical institute. Prescription of minimum standards for medical education, authority to recognise or de-recognise an institution etc., are areas over which exclusive legislative competence lies with the Parliament, under Entry 66 of List I.

Hence, the Assam Act is liable to be set aside.

Constitutionality of the 2015 Act

The Assam Community Professional (Registration and Competency) Act, 2015 was enacted by the State of Assam with a view to remove the basis of the impugned judgment of the Gauhati High Court and to restore the position of the diploma holders in medicine and to give them continuity in service.

The Court explained that while the Legislature cannot directly overrule a judicial decision, it can, however, remove the substratum or foundation of a judgment to make the decision ineffective, provided it does not transgress on any other constitutional limitation. Such legislative device which removes the vice in previous legislation which has been declared unconstitutional is not considered an encroachment on judicial power but an instance of abrogation. But where there is a mere validation without the defect being legislatively removed, the legislative action will amount to overruling the judgment by a legislative fiat which is invalid.

Hence, it was held that the 2015 Act has been enacted with a view to restore the position of the diploma holders in medicine and to give them continuity in service. The said Act has been enacted by a valid legislative exercise and does not transgress any other constitutional limitation and in accordance with Entry 25 of List III of the Seventh Schedule and is not in conflict with the IMC Act, 1956 and the rules and regulations made thereunder as per Entry 66 of List I of the Seventh Schedule. Hence, the 2015 Act is within the legislative competence of the State Legislature under the Seventh Schedule of the Constitution.

[Baharul Islam v. Indian Medical Association, 2023 SCC OnLine SC 79, decided on 24.01.2023]

*Judgment authored by: Justice BV Nagarathna

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Advocates who appeared in this case :

For Petitioner(s): Mr. Harin P Raval, Sr. Adv. Mr. Sanjay R Hegde, Sr. Adv. Mr. Rana Mukherjee, Sr. Adv. Mr. Adeel Ahmed, AOR Mr. Raja Chatterjee, Adv. Mr. Piyush Sachdev, Adv. Ms. Oindrila Sen, Adv. Mr. Md Sharuk Ali, Adv. Mr. Raghav Gupta, Adv. Ms. Shreya, Adv. Ms. Shrestha Narayan, Adv. Mr. Aditya Pathak, Adv. Mr. Satish Kumar, AOR

For Respondent(s): Mr. Shivam Singh, Adv. Mr. Abhinav Singh, Adv. Mr. Deep Prabhu, Adv. Ms. Shaswati Parhi, Adv. Mr. Manish Kumar, AOR Mr. Gagan Gupta, AOR Mr. Shuvodeep Roy, AOR Mr. Arnav Singh Deo, Adv. Mr. Deepayan Dutta, Adv. Mr. Vikas Singh, Sr. Adv. Mr. Gaurav Sharma, AOR Mr. Dhawal Mohan, Adv. Mr. Prateek Bhatia, Adv. Mr. Paranjay Tripathi, Adv. Mr. K.M. Nataraj, Ld. ASG Mr. Vatsal Joshi, Adv. Mr. Nakul Chengappa, Adv. Mr. Sharathj Nambiar, ADv. Mr. Vinayak Sharma, Adv. Mr. Anuj S. Udupa, ADv. Mr. Nakul Chengappa K.K., ADv. Mr. Chitransh Sharma, Adv. Mr. Gurmeet Singh Makker, AOR Mr. Ananga Bhattacharyya, AOR Mr. V.K. Kanna, Adv. Mr. Hitesh Kumar Sharma, Adv. Mr. Akhileshwar Jha, Adv. Ms. Niharika Dwivedi, Adv. Ms. Shweta Sand, Adv. Mr. Narendra Pal Sharma, Adv. Mr. Amit Kumar Chawla, Adv. Mr. Ravish Kumar Goyal, Adv.