SC bans Assam Diploma Doctors to Treat Specified Diseases, Perform Minor Procedures

New Delhi: Observing that the Assam Rural Health Regulatory Authority Act, 2004 lacked necessary competence, the Supreme Court on Tuesday set it aside. The concerned state law allowed the diploma holders in Medicine and Rural Health Care for treating certain common diseases, perform minor procedures, and prescribe certain drugs.

Earlier back in 2014, the Gauhati High Court had also declared the Act to be unconstitutional and ultra vires and referring to this, a division bench of Justices B.R. Gavai and B.V. Naharathna observed, “The Assam Act seeks to regulate such aspects of medical education [that are within the exclusive domain of the Parliament], and is liable to be set aside on the grounds that the state legislature lacks the necessary competence.”

These observations were made by the division bench of the Supreme Court while it was considering an appeal by special leave against the Gauhati High Court order, which had dismissed the Act holding that it was ultra vires the Indian Medical Council Act, 1956.

Around two decades ago, the Assam Government had introduced the three-year diploma course for strengthening the rural healthcare infrastructure by creating a cadre of barefoot doctors allowed to practice modern medicine, to a certain extent.

Referring to the Section 10A of the Indian Medical Council Act, the Gauhati High Court had held that the Government should have sought approval from the Central Government before introducing the said diploma course.

Taking note of the fact that there was lack of permission from the central government as well as the lack of presidential assent. Therefore, the HC bench had set aside the Act holding it to be unconstitutional.

While Advocate-on-Record Shuvodeep Roy represented the Assam Government, the Union Government was represented by the Additional Solicitor-General K.M. Nataraj. Besides, the National Medical Commission (NMC), the Indian Medical Association (IMA), and other private parties were also involved in the case hearing.

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As per the latest media report by the Live Law, while considering the matter, the Supreme Court bench noted that the Assam Act had been enacted on the strength of Entry 25 of List III and it not only sought to introduce a new force in the field of medical education but also regulated the profession of successful candidates. Apart from this, the bench opined that the regulatory authority set up under the Act was imbued with the power to prescribe the minimum standards of the course, as well as other particulars such as the duration, curriculum, pedagogy, and examination.

The top court bench also opined that the concerned Act also authorised the State Government for granting permission for setting up medical institutes. The bench observed that these would be covered within the legislative field of coordination and determination of standards in institutions for higher education or research and scientific and technical institutions under Entry 66 of the Union List.

Therefore, objecting to the attempt of the State for encroaching into the exclusive domain of the Parliament, the bench comprising Justice Nagarathna pronounced,

“It is essential that uniform standards are laid down by the Parliament which are adhered to by institutions and medical colleges across the country. To this end, Entry 66 has been formulated with the objective of maintaining uniform standards in 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 derecognise an institution, et cetera…The particular qualifications for medical practitioners practising in disparate areas and in disparate fields, providing different levels of primary, secondary, or tertiary medical services, are within the mandate of expert and statutory authorities entrusted with the said mandate by the Parliament.”

The bench also distinguished between the doctrine of repugnancy and the doctrine of occupied field and explained that repugnancy arose only in the event of an actual conflict between a state law and a union law, both of which were enacted by the respective legislatures, not in excess of their competence. Therefore, the bench observed that this was a case where the relevant legislative entry of the state list was expressly made 'subject' to a corresponding entry in the union list.

Declaring that the Assam legislature lacked the necessary legislative competence, the top court bench further observed,

“The doctrine of repugnancy as such would not apply within the meaning of Article 254 of the Constitution… Although Entry 25 of List III gives powers to both the central and state legislatures to pass laws on the subject of education, it is significant to note that any such law made by the state legislature is subject to, inter alia, Entry 66 of List I. Hence, where there is a direct conflict between a state law and a union law over a matter of the coordination and determination of standards in institutions for higher education, such as in medical education concerning modern medicine, the state law cannot have any validity as the state legislature does not possess legislative competence.” Justice Nagarathna explained pithily, “What we are saying is, it is not repugnancy, but subject to.”

The bench also referred to the directive principle of state policy requiring the union and the state governments regarding the improvement of the public health as their primary duty and observed, "It follows from this directive that the state shall make all possible efforts to ensure equitable access to health services. These efforts must be made to progressively realise the right of everyone to the enjoyment of the highest attainable standards of physical and mental health, as acknowledged in international conventions and agreements."

However, the bench also noted that the State had the right to devise policies for public health and medical education regarding peculiar social and financial conditions, policies that cause an unfair disadvantage towards any class of citizens, ought not be formulated.

Therefore, the bench insisted,

“The citizens residing in rural areas have an equal right to access healthcare services by duly qualified staff. Policies for enhancing access to rural healthcare must not short-change. The citizens residing in rural areas are subjected to direct and indirect forms of discrimination on the basis of their place of birth or residence. Any variation in the standards of the qualifications required of medical practitioners who render services in rural areas qua those rendering services in urban and metropolitan areas circumscribe constitutional values of substantive equality and non-discrimination.”

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