New Delhi : The Supreme Court bench of Justices B.R. Gavai and B.V. Nagarathna said that a state legislature has no legislative competence to enact a law in respect of modern medicine or allopathic medicine, contrary to the standards that have been determined by the central law. The bench emphasised that policies for enhancing access to rural healthcare must not “short-change” the citizens residing in rural areas or subject them to direct or indirect forms of unfair discrimination on the basis of their place of birth or residence.
The bench has upheld a previous judgment by the Guwahati high court barring the diploma holders in Assam from treating patients suffering from common diseases, perform minor procedures and prescribe certain drugs. The Supreme Court struck down the Assam Rural Health Regulatory Authority Act 2004 and in turn banned the three year diploma course introduced by the Assam government almost two decades ago, to strengthen the rural healthcare infrastructure by producing a cadre of barefoot doctors allowed to practice modern medicine, albeit to a very limited extent.
“Any variation between the standards of qualification required for medical practitioners who render services in rural areas qua the medical practitioners rendering services in urban or metropolitan areas must prescribe to constitutional values of substantive equality and non-discrimination.” It said that deciding the particular qualifications for medical practitioners practising in disparate areas and in disparate fields, providing different levels of primary, secondary or tertiary medical services, is within the mandate of expert and statutory authorities entrusted with the mandate by the Parliament.
The Supreme Court bench ruled that prescription of minimum standards for higher education, the power of authorities to recognise or de-recognise an institution etc are areas over which the exclusive legislative to make law lies with the parliament under Entry 66 List 1 of the Constitution, and not the state legislature. “The Assam Act which seeks to regulate such aspects of medical education is therefore liable to be set aside on the ground that the state legislature lacks the competence to legislate with respect to the aspects enumerated above,” the Supreme Court said.
The Indian Medical Association (IMA), the main respondent in the case, had argued that the Assam Act discriminates between patients living in rural areas and those living in urban areas, implying that the persons who live in urban areas are entitled to standard treatment and those who live in rural areas are entitled to sub-standard treatment. “There are more than 2,244 MBBS doctors working in the rural areas of Assam; even if there is a shortfall of doctors in the rural areas and the Assam Act aims to remedy the shortfall, the solution lies in increasing their coverage via permissible means and not otherwise,” it had submitted.