Summary
The Assam Rural Health Regulatory Authority Act, 2004 set up a diploma course allowing Rural Health Practitioners to practise allopathic medicine in rural Assam. The Gauhati High Court struck it down as repugnant to the Indian Medical Council Act, 1956. The Supreme Court upheld the result but corrected the reasoning. Minimum standards of medical education and recognition of institutions fall under Entry 66 of List I, to which Entry 25 of List III is subject. The State therefore lacked legislative competence, and Article 254 repugnancy did not arise. The Assam Community Health Professionals Act, 2015, which re-designated the diploma holders, was held valid.
Issues
- Whether the Assam Legislature had legislative competence to enact the Assam Rural Health Regulatory Authority Act, 2004, providing for a diploma course and practice of allopathic medicine in rural areas, and whether the High Court rightly struck it down on the ground of repugnancy under Article 254.
- Whether the Assam Community Health Professionals (Registration and Competency) Act, 2015, enacted after the High Court's judgment, is valid.
Provisions considered
- Seventh Schedule, Entry 66 of List I and Entry 25 of List III; Article 254, Constitution of IndiaEntry 25 of List III is subject to Entry 66 of List I, so a State law trenching on coordination and determination of standards in medical education is void for want of competence; repugnancy under Article 254 arises only where both laws are within the concurrent field. (¶¶ 20, 21, 24, 25)
- Sections 2(f), 2(h), 10A, 10B, 11, 13, 15, 21 and 33, Indian Medical Council Act, 1956Modern scientific medicine includes allopathy; practice requires a recognised medical qualification in the Schedules and enrolment on a State Medical Register, and the Council prescribes courses, training and standards of proficiency. (¶¶ 17, 20)
- Sections 2, 7, 8, 17 and 24, Assam Rural Health Regulatory Authority Act, 2004The Act let a State authority prescribe minimum standards, curriculum and examinations, the State permit medical institutes, and diploma holders treat diseases, prescribe drugs, perform minor surgery and issue certificates without a recognised qualification. (¶¶ 18, 19, 20, 21)
- Section 3, Assam Community Health Professionals (Registration and Competency) Act, 2015Diploma holders and students were deemed to have the status of B.Sc. (Community Health) graduates and registered as Community Health Professionals to serve as paramedical personnel. (¶¶ 22, 25)
Held
- Prescription of minimum standards of medical education, the course, curriculum and examination, and recognition or de-recognition of institutions fall within Entry 66 of List I; the 2004 Act regulated these aspects and allowed under-qualified diploma holders to perform functions of medical practitioners in allopathy, so it is null and void as the Assam Legislature lacked competence. (¶¶ 20, 21, 25)
- Mukhtiar Chand, Subhasis Bakshi and A.K. Sabhapathy do not assist the appellants, since they confirm that practice of allopathic medicine requires a recognised medical qualification under the Central Act. (¶ 21)
- The High Court's conclusion is upheld but its reasoning is incorrect: where a State law under Entry 25 of List III directly conflicts with a Union law on standards under Entry 66 of List I, the State law fails for want of competence and the doctrine of repugnancy under Article 254 does not apply. (¶¶ 23, 24, 25)
- A competent legislature may remove the basis of a judgment retrospectively but cannot simply overrule it (Indian Aluminium, Prithvi Cotton Mills); the 2015 Act validly removes that basis, is within Entry 25 of List III and does not conflict with the IMC Act, which does not deal with community health professionals; no view was expressed on its compatibility with the National Medical Commission Act, 2019. (¶¶ 22, 24, 25)
- Under Article 47, rural citizens are entitled to healthcare from duly qualified staff, and any variation in qualifications between rural and urban practitioners must respect substantive equality, the choice of qualifications being for expert statutory bodies. (¶ 24)
Result
Civil Appeals arising out of SLP (C) Nos. 32592-32593 of 2015 against the Gauhati High Court judgment dated 30.10.2014 dismissed, and Transferred Case (C) Nos. 24 and 25 of 2018 challenging the 2015 Act dismissed; parties to bear their own costs.