Regulating Unqualified Medical Practitioners in India: Legal Framework and Judicial Responses

Regulating Unqualified Medical Practitioners in India: Legal Framework and Judicial Responses

1. Introduction

The phenomenon of persons rendering medical care without possessing recognised qualifications—colloquially referred to as “quacks” or “unqualified medical practitioners” (UMPs)—poses a persistent threat to public health in India. Judicial pronouncements over the last three decades have confronted the civil, criminal and regulatory dimensions of this threat while balancing the constitutional right to practise a profession with the State’s obligation to protect life and health. This article critically analyses the evolving jurisprudence, statutory architecture and policy measures governing UMPs, drawing primarily upon the Supreme Court’s decisions in Poonam Verma[1], Jacob Mathew[2], Dr Mukhtiar Chand[3] and allied authorities.

2. Historical and Policy Context

At independence India faced an acute shortage of qualified doctors. Successive governments tolerated, and in some instances informally regulated, experienced but unqualified healers to plug the rural healthcare gap. Contemporary data, however, reveal a proliferation of UMPs even in urban areas, often armed with spurious diplomas and unrestricted access to potent allopathic drugs. The Supreme Court has repeatedly described this trend as a “menace to society”[4]. Simultaneously, State notifications under the Drugs and Cosmetics Rules, 1945, have attempted to confer limited prescribing rights on certain traditional practitioners to meet local needs, creating a complex regulatory mosaic.

3. Constitutional and Statutory Framework

3.1 Constitutional Dimensions

Article 19(1)(g) guarantees the freedom to practise any profession, but Article 19(6) permits the State to impose “reasonable restrictions” in the interests of the general public. The Supreme Court has held that legislation prescribing professional or technical qualifications for medical practice is a paradigmatic example of a reasonable restriction[5]. Further, Article 21’s guarantee of life and personal liberty encompasses the right to receive safe medical treatment, reinforcing the State’s regulatory duty.

3.2 Central Statutes

  • Indian Medical Council Act, 1956 (IMC Act): Section 15 prohibits practice of modern medicine by anyone other than a person possessing a recognised medical qualification and registration on a State Medical Register[6].
  • Indian Medicine Central Council Act, 1970 (IMCC Act): Section 17 similarly restricts practice of Ayurveda, Siddha and Unani systems to duly qualified and registered persons[7].
  • Drugs and Cosmetics Act, 1940 & Rules, 1945: Rule 2(ee)(iii) allows State Governments to declare specified categories of practitioners as “registered medical practitioners” for the limited purpose of prescribing drugs[8].
  • Consumer Protection Act, 1986: Sections 2(1)(d) & (o) define patients availing paid medical services as “consumers”, exposing providers—qualified or otherwise—to civil liability for deficiency in service[9].
  • Indian Penal Code, 1860: Section 304-A criminalises causing death by a rash or negligent act; sections 336–338 address acts endangering human life. These provisions ground criminal prosecutions of UMPs.

4. Civil Liability: Negligence and “Service” under the Consumer Protection Act

In Indian Medical Association v. V.P. Shantha the Supreme Court affirmed that paid medical services constitute “service”, enabling consumers to seek compensation for negligence before consumer fora[10]. Significantly, the Court rejected the argument that medical professionals occupy a sui generis category beyond consumer law, thereby subjecting UMPs—who often charge fees—to the same regime.

Poonam Verma v. Ashwin Patel extended this reasoning. A homoeopath who prescribed allopathic drugs without requisite qualifications was held “negligent per se” because the very act of practising outside one’s authorised system violates statutory mandates[1]. The Court awarded compensation and directed disciplinary action, crystallising three principles:

  1. Practising a medical system without statutory authorisation is an independent wrong.
  2. Such unauthorised practice ipso facto breaches the duty of care; no Bolam-style expert evidence is required.
  3. Consumer fora may grant redress despite simultaneous penal liability.

5. Criminal Liability: From Ordinary Negligence to Gross Recklessness

The threshold for criminal culpability was clarified in Jacob Mathew v. State of Punjab. The Court distilled the principle that mere error or ordinary negligence—however actionable in tort—does not suffice for conviction under Section 304-A IPC. Criminal liability demands gross negligence or recklessness evincing “mens rea”[2]. Although Jacob Mathew concerned qualified doctors, its ratio governs prosecutions of UMPs as well. Accordingly:

  • Where the sole allegation is lack of qualification, conviction may proceed without proving mens rea, because practising medicine in defiance of Section 15 IMC Act is malum prohibitum and often treated as negligence per se.
  • Where death or grievous hurt ensues, prosecutors must additionally establish a causal link and the heightened degree of negligence specified in Jacob Mathew.

High Courts have embraced this approach. In Ch. Venkateswara Rao, the Andhra Pradesh High Court refused leniency for an unqualified practitioner selling allopathic drugs, branding the practice “a menace to society”[11]. Conversely, courts have warned against indiscriminate arrests, mandating preliminary expert opinions to filter frivolous prosecutions[12].

6. Regulatory Accommodation and State Notifications

6.1 The Dr Mukhtiar Chand Exception

In a nuanced judgment, the Supreme Court upheld State notifications issued under Rule 2(ee)(iii) recognising certain vaids and hakims as “registered medical practitioners” for prescribing specified allopathic drugs, provided such recognition conformed to State legislation[3]. The Court emphasised that clause (iii) is residual—operative only when practitioners are not covered by clauses (i) & (ii) relating to modern medicine. Thus:

  • The notifications do not authorise full-fledged practice of modern medicine; surgery, obstetrics and the use of scheduled drugs remain prohibited.
  • States must ensure that traditional practitioners possess integrated qualifications or adequate training.

6.2 Recent Judicial Scrutiny

In Kerala Ayurveda Paramparya Vaidya Forum the Supreme Court reiterated that any relaxation of statutory standards must be narrowly tailored and cannot legitimise quackery[4]. The Kerala High Court in Central Council of Indian Medicine v. State of Kerala echoed this stance, warning that public health considerations outweigh individual livelihood claims[13].

6.3 Administrative Circulars and “Registration” Schemes

Periodically, the Union Ministry of Health has urged States to consider transitional registration of experienced UMPs subject to restrictions (e.g., prohibition on surgery, use of dangerous drugs). However, attempts by UMPs to compel such registration through writ petitions have mostly failed. The Madras High Court in I. Dorairaj dismissed a plea for blanket recognition, holding that only legislation—not executive circulars—can dilute statutory qualification requirements[14].

7. Enforcement Challenges

  • Resource Constraints: Rural health deficits often compel communities to rely on UMPs, complicating enforcement.
  • Multiplicity of Registers: Overlapping State registers for various systems invite ambiguity exploited by UMPs.
  • Evidentiary Hurdles: Establishing causal links in criminal trials against UMPs demands expert testimony, increasing prosecution costs.
  • Harassment Allegations: Courts have cautioned police against indiscriminate crackdowns that violate procedural safeguards[12].

8. Reconciling Public Health with Individual Rights: A Normative Appraisal

Jurisprudence reflects an incremental tightening of the regulatory noose around UMPs while preserving limited space for qualified traditional practitioners. The “negligence per se” doctrine in Poonam Verma appropriately treats statutory breach as tortious fault, facilitating consumer redress. Simultaneously, the elevated criminal standard in Jacob Mathew averts chilling effects on bona fide medical discretion. The residual clause of Rule 2(ee)(iii), as interpreted in Dr Mukhtiar Chand, provides a pragmatic—though narrowly circumscribed—safety valve in underserved areas. The challenge is to operationalise this jurisprudence through uniform guidelines, continuous surveillance and public awareness.

9. Recommendations

  1. Uniform National Register: Integrate State medical registers with a real-time national database accessible to enforcement agencies.
  2. Graduated Penalties: Amend the IMC Act to introduce graded sanctions—from administrative fines to imprisonment—linked to the gravity and recurrence of unauthorised practice.
  3. Community Health Worker Certification: Create accredited short-term programmes for basic primary care, clearly demarcating permissible activities to reduce reliance on UMPs.
  4. Public Awareness Campaigns: Mandate disclosure requirements (e.g., display of qualification and registration numbers) and impose consumer fines for non-compliance.
  5. Strengthen Drug Supply Chain Monitoring: Enforce licence requirements on wholesalers and pharmacies to prevent diversion of scheduled drugs to UMPs.

10. Conclusion

The Supreme Court has unequivocally declared that the right to practise medicine is conditioned upon possession of statutorily recognised qualifications and registration. Unqualified practice constitutes negligence per se in civil law and invites criminal sanction where gross negligence or statutory breach is proved. Limited statutory accommodations exist for certain traditional practitioners, but they do not legitimise quackery. Effective enforcement, harmonised legislation and community education are indispensable to translating these legal norms into tangible protection for India’s public health.

Footnotes

  1. Poonam Verma v. Ashwin Patel, (1996) 4 SCC 332.
  2. Jacob Mathew v. State of Punjab, (2005) 6 SCC 1.
  3. Dr Mukhtiar Chand v. State of Punjab, (1998) 7 SCC 579.
  4. Kerala Ayurveda Paramparya Vaidya Forum v. State of Kerala, (2018) SC (unreported, extracted portion in materials).
  5. Id.; see also Art. 19(1)(g) & 19(6), Constitution of India.
  6. Indian Medical Council Act, 1956, s. 15.
  7. Indian Medicine Central Council Act, 1970, s. 17.
  8. Drugs and Cosmetics Rules, 1945, r. 2(ee)(iii).
  9. Consumer Protection Act, 1986, ss. 2(1)(d) & (o); Indian Medical Association v. V.P. Shantha, (1995) 6 SCC 651.
  10. Ibid.
  11. Ch. Venkateswara Rao v. State of A.P., 2010 SCC OnLine AP 1033.
  12. Guidelines in Jacob Mathew (supra) applied in KAMLESH v. Dr. Anup Padmawar, Dist. Consumer Forum, 2017.
  13. Central Council of Indian Medicine v. State of Kerala, Kerala HC, 2020.
  14. I. Dorairaj v. State of Tamil Nadu, Madras HC, 2023.