Unregistered Medical Practitioners in India: A Legal Analysis of Qualification, Regulation, and Accountability
Introduction
The practice of medicine in India is governed by a complex web of central and state legislations designed to ensure that medical services are provided by qualified and registered professionals. However, the phenomenon of unregistered medical practitioners, often colloquially termed "quacks," poses a significant challenge to public health and the integrity of the medical profession. These individuals may lack the requisite qualifications, operate outside the scope of their training, or possess degrees from unrecognized institutions, thereby endangering patient safety. This article undertakes a comprehensive legal analysis of the regulatory framework concerning unregistered medical practitioners in India, drawing upon key statutory provisions and judicial pronouncements. It examines the definition of an unregistered practitioner, the legal prohibitions and consequences of such practice, the intricate relationship between different systems of medicine, the persistent problem of quackery, and the evolving regulatory landscape under the National Medical Commission Act, 2019.
Defining the "Unregistered Medical Practitioner" in India
The Legislative Mandate for Registration
The foundation of medical regulation in India lies in the mandatory registration of practitioners. Historically, the Indian Medical Council Act, 1956 (IMC Act) and the Indian Medicine Central Council Act, 1970 (IMCC Act) were pivotal. The IMC Act, 1956, particularly Section 15, mandated that no person other than a medical practitioner enrolled on a State Medical Register could practice modern scientific medicine (BAHARUL ISLAM . v. THE INDIAN MEDICAL ASSOCIATION, 2023). Similarly, Section 17 of the IMCC Act, 1970, stipulated requirements for practitioners of Indian systems of medicine (Charan Singh And Others v. State Of U.P And Others, Allahabad High Court, 2004). These have now been largely superseded or impacted by the National Medical Commission Act, 2019 (NMC Act).
State Medical Councils, established under various state enactments (e.g., Maharashtra Medical Council Act, 1965, as cited in Poonam Verma v. Ashwin Patel And Others, Supreme Court Of India, 1996), are responsible for maintaining State Medical Registers. Enrollment on these registers is typically contingent upon possessing "recognised medical qualifications." The NMC Act, 2019 continues this system with the National Medical Register and State Medical Registers (DR NAMIT GUPTA v. DELHI MEDICAL COUNCIL AND ANR, Delhi High Court, 2024).
Identifying an "Unregistered" Practitioner
An "unregistered medical practitioner" can be characterized in several ways:
- An individual practicing medicine without any formal medical qualification from a recognized institution.
- A person holding a medical qualification but not enrolled on the relevant State Medical Register or the National Medical Register as required by law (Poonam Verma v. Ashwin Patel And Others, Supreme Court Of India, 1996; IMC Act, 1956, S. 15(2)).
- A practitioner qualified and registered in one system of medicine (e.g., Homoeopathy) but practicing another system (e.g., Allopathy) without specific authorization or qualification in that other system (Poonam Verma v. Ashwin Patel And Others, 1996 SCC 4 332).
- An individual possessing degrees or diplomas from institutions not recognized by the competent statutory bodies (Pradeep Kumar v. Union Of India & Others, Allahabad High Court, 2010, regarding Hindi Sahitya Sammelan degrees post-1967; Dr. Smt. Ummul Ola v. Rajesh Kumar Srivastava, Allahabad High Court, 2012).
Legal Prohibitions and Ramifications of Unregistered Practice
Statutory Bar on Practice
The primary legal consequence of being unregistered is the prohibition on practicing medicine. Section 15(2)(b) of the IMC Act, 1956, explicitly stated that no person other than a medical practitioner enrolled on a State Medical Register shall practice medicine in any State (BAHARUL ISLAM . v. THE INDIAN MEDICAL ASSOCIATION, 2023). Contravention was punishable under Section 15(3) with imprisonment or fine or both (Poonam Verma v. Ashwin Patel And Others, Supreme Court Of India, 1996; MAMTA v. STATE OF HARYANA, Punjab & Haryana High Court, 2024). The NMC Act, 2019, in Sections 33 and 34, carries forward similar prohibitions, with Section 33(2) stipulating penalties for contravention, including imprisonment and substantial fines (DR NAMIT GUPTA v. DELHI MEDICAL COUNCIL AND ANR, Delhi High Court, 2024). Similar prohibitions exist under the IMCC Act, 1970, for practitioners of Indian medicine (S. 17).
Restrictions on Prescribing Medicines
The ability to prescribe drugs, particularly allopathic medicines, is intrinsically linked to being a "Registered Medical Practitioner" (RMP) as defined under Rule 2(ee) of the Drugs and Cosmetics Rules, 1945 (V. Loganathan v. State By Drug Inspector, Madras High Court, 1991). This definition includes persons holding qualifications under the IMC Act (now NMC Act), those registered on a State Medical Register for modern scientific medicine, and crucially, under sub-clause (iii), persons declared by a State Government order as practicing the modern scientific system of medicine. Unregistered practitioners, not falling under this definition, are generally barred from prescribing scheduled drugs, and stocking such drugs can lead to prosecution under the Drugs and Cosmetics Act, 1940 (MAMTA v. STATE OF HARYANA, Punjab & Haryana High Court, 2024).
Civil Liability: Negligence and Consumer Protection
An unregistered practitioner who administers treatment can be held liable for medical negligence. The Supreme Court in Poonam Verma v. Ashwin Patel And Others (1996 SCC 4 332) held that a person practicing a system of medicine without the requisite qualifications and registration is engaged in an illegal act and amounts to negligence per se. The Court observed that such a person is a "quack" or an "imposter." Furthermore, services rendered by medical practitioners for consideration fall under the purview of the Consumer Protection Act, 1986 (now Consumer Protection Act, 2019), making them liable for deficiency in service (Indian Medical Association v. V.P Shantha And Others, 1995 SCC 6 651). This principle would extend to unregistered practitioners who charge fees for their services.
Criminal Culpability
Beyond statutory penalties under medical acts, unregistered practitioners may face criminal charges under the Indian Penal Code, 1860 (IPC). This can include Section 304A (causing death by rash or negligent act), Section 336 (act endangering life or personal safety of others), or Section 420 (cheating) (MAMTA v. STATE OF HARYANA, Punjab & Haryana High Court, 2024; AMARESH S/O GAVISIDDAPPA KALLUR v. THE STATE OF KARNATAKA, Karnataka High Court, 2021). While the Supreme Court in Jacob Mathew v. State Of Punjab And Another (2005 SCC 6 1) set a high threshold for criminal negligence against qualified doctors (requiring gross recklessness or 'culpa lata'), the act of practicing without any qualification itself may be viewed differently, especially if it leads to harm. Additionally, specific state laws, like the Maharashtra Medical Practitioners Act, 1961, provide for penalties for unregistered practice (YOGESHWAR S/O. JAYRAM KAMBLE v. THE STATE OF MAHARASHTRA, Bombay High Court, 2019, conviction under S. 33(2)(a)).
Navigating Cross-System Practice and State Regulatory Powers
The General Prohibition on Practicing Unqualified Systems
A fundamental principle is that a practitioner qualified and registered in one system of medicine is generally not permitted to practice another system in which they are not qualified. In Poonam Verma v. Ashwin Patel And Others (1996 SCC 4 332), a homoeopathic practitioner administering allopathic medicines was held negligent, as his registration under the Bombay Homoeopathic Practitioners' Act, 1959, restricted him to practicing homoeopathy.
The Mukhtiar Chand Exception: State Empowerment and its Limits
A significant nuance was introduced by the Supreme Court in Dr Mukhtiar Chand And Others v. State Of Punjab And Others (1998 SCC 7 579). The Court upheld the validity of Rule 2(ee)(iii) of the Drugs and Cosmetics Rules, 1945, and state notifications issued thereunder, which allowed certain vaids/hakims (practitioners of Indian medicine) registered under state laws and often possessing integrated course qualifications, to prescribe allopathic medicines. This recognized the state's power to declare certain practitioners as RMPs for the purposes of the Drugs Act, 1940, especially to meet healthcare needs in underserved areas. However, this power is not absolute. In Dr. A.K Sabhapathy v. State Of Kerala And Others (1992 SUPP SCC 3 147), the Supreme Court held that state provisions allowing individuals to practice modern medicine without qualifications recognized under the central IMC Act, 1956, would be repugnant to the central legislation and therefore void. The Central Act's standards for modern medicine prevail.
Special Dispensation for Community and Rural Health Practitioners
Building on the principles of Mukhtiar Chand, the Supreme Court in Subhasis Bakshi And Others v. W.B Medical Council And Others (2003 SCC 9 269) recognized the rights of Diploma in Community Medical Services (Dip. CMS) holders in West Bengal. The Court affirmed that their right to treat in rural areas inherently included the rights to prescribe medicines and issue medical certificates, and they were entitled to be registered in the State Medical Register for this purpose, even if they did not hold "recognized medical qualifications" in the traditional sense under the IMC Act.
The Challenge of "Quackery" and Unrecognized Qualifications
Judicial Condemnation of Unqualified Practice
Courts have repeatedly expressed concern over the proliferation of unqualified medical practitioners. The Allahabad High Court in Ravindra Kumar Goel (Dr.) And Others v. State Of Uttar Pradesh And Another (2004) noted that a large number of "unauthorised medical practitioners (quacks) have mushroomed," posing a hazard to public health. This sentiment was echoed in cases like Charan Singh And 3 Ors.; ... v. State Of U.P.& Ors. (Allahabad High Court, 2004), which cited the Supreme Court's observations in D.K. Joshi v. State of U.P. (2000 (5) SCC 80) about the failure of authorities to curb this menace. The practice of unrecognized "pathys" like Electro-homeopathy has also been a subject of judicial scrutiny (Dr. Smt. Ummul Ola v. Rajesh Kumar Srivastava, Allahabad High Court, 2012).
The Issue of Degrees from Unrecognized Institutions
A persistent issue is the claim to practice based on degrees or diplomas from institutions that are not authorized to confer recognized medical qualifications. For instance, qualifications like 'Ayurvedic Ratna' from Hindi Sahitya Sammelan, Prayag, obtained after 1967, have been held not to be recognized under the IMCC Act, 1970, for the purpose of practicing Indian medicine (Pradeep Kumar v. Union Of India & Others, Allahabad High Court, 2010; Dr. Smt. Ummul Ola v. Rajesh Kumar Srivastava, Allahabad High Court, 2012). Registration by a state board based on such unrecognized degrees does not validate practice in other states or confer legitimacy.
Enforcement Deficiencies and Judicial Interventions
Despite clear legal prohibitions, enforcement against unregistered practitioners has often been lax. This has led to judicial interventions, with courts issuing directives to state authorities to identify, prosecute, and prevent such illegal practices (Charan Singh And 3 Ors.; ... v. State Of U.P.& Ors., Allahabad High Court, 2004, citing D.K. Joshi). Public Interest Litigations have sought directions for action against unqualified individuals practicing dentistry (Dr. Hemendra Singh Petitioner v. State Of Uttarakhand & Others, Uttarakhand High Court, 2016) or other branches of medicine. Courts have also directed authorities to ensure that practitioners display their registration details and have restrained media from publishing advertisements by unauthorized practitioners (Ravindra Kumar Goel (Dr.) And Others v. State Of Uttar Pradesh And Another, Allahabad High Court, 2004). The very act of forming associations of "unqualified medical practitioners" and seeking judicial protection from penal provisions has been noted by courts (President v. Commissioner, Madras High Court, 2016).
The Regulatory Shift: From the Indian Medical Council Act, 1956 to the National Medical Commission Act, 2019
Continuity and Change in the New Regime
The National Medical Commission Act, 2019 (NMC Act) has replaced the IMC Act, 1956, bringing significant changes to medical education and regulation. Sections 33 and 34 of the NMC Act deal with the National Register and State Registers, and the rights of persons included therein to practice medicine. Section 34(1) of the NMC Act states that no person other than one enrolled in the State Register or the National Register shall practice medicine. Section 33(2) provides for punishment for contravention. The Delhi High Court in DR NAMIT GUPTA v. DELHI MEDICAL COUNCIL AND ANR (2024) observed that the omission of expressions like "in any State" or "any part of India" (which were present in the IMC Act) in the corresponding provisions of the NMC Act (Sections 33 and 34) indicates a legislative intent to restrict medical practitioners to practicing only in States or Union Territories where they are registered. The judgment also noted that enabling registration with more than one State Medical Council under the Regulations of 2023 further supports this restrictive interpretation, aiming to ensure practitioners are amenable to the regulatory jurisdiction of the State Medical Council where they practice.
Conclusion
The legal framework in India unequivocally prohibits the practice of medicine by unregistered and unqualified individuals. Central and state legislations, spearheaded by the erstwhile IMC Act and now the NMC Act, along with the IMCC Act and Drugs and Cosmetics Act, establish stringent requirements for qualification, registration, and adherence to professional standards. Judicial pronouncements have consistently upheld these requirements, emphasizing patient safety and condemning quackery. While provisions exist for recognizing practitioners of traditional systems and community health workers under specific conditions, these do not dilute the overarching mandate for recognized qualifications and registration. The transition to the NMC Act regime seeks to further strengthen regulatory oversight. However, the persistent challenge lies in effective enforcement to eradicate the menace of unregistered practitioners and ensure that medical care across India is delivered only by those legally authorized and competent to do so, thereby safeguarding public health and maintaining the sanctity of the medical profession.