Supreme Court Upholds Restrictions on Unqualified Traditional Medicine Practitioners: Kerala Ayurveda Paramparya Vaidya Forum vs. State of Kerala (2018)

LEGAL ISSUE: Whether individuals lacking formal qualifications and registration can practice traditional medicine as ‘Paramparya Vaidyas’.
CASE TYPE: Regulatory Law/Health Law
Case Name: Kerala Ayurveda Paramparya Vaidya Forum vs. State of Kerala and Others
[Judgment Date]: 13 April 2018

Date of the Judgment: 13 April 2018
Citation: 2018 INSC 319
Judges: R.K. Agrawal, J. and Mohan M. Shantanagoudar, J.
Can individuals practice traditional medicine without formal qualifications? The Supreme Court of India tackled this critical question in a case involving ‘Paramparya Vaidyas’ in Kerala. The court examined the balance between traditional practices and the need for regulated medical qualifications, ultimately ruling against the practice of medicine without proper registration and qualifications. This judgment underscores the importance of standardized medical practices for public health.

Case Background

In Kerala, many individuals known as ‘Paramparya Vaidyas’ practice traditional systems of medicine like Ayurveda, Siddha, and Unani. This knowledge is typically passed down through families. The Kerala Ayurveda Paramparya Vaidya Forum, an association of these practitioners, sought to protect their right to practice. The enactment of the Travancore-Cochin Medical Practitioners Act, 1953, required practitioners to be registered, which effectively barred many ‘Paramparya Vaidyas’ from practicing unless they met the registration criteria. This led to numerous petitions before the High Court, arguing that their traditional practices should be recognized.

Timeline

Date	Event
1953	The Travancore-Cochin Medical Practitioners Act was enacted, requiring registration for medical practitioners.
1955	Kerala Ayurveda Paramparya Vaidya Forum was registered under the Travancore-Cochin Literary, Scientific and Charitable Societies Registration Act.
1956	The Indian Medical Council Act, 1956 came into force.
1970	The Indian Medicine Central Council Act, 1970 (IMCC Act) came into force, regulating indigenous medicine.
1973	The Homoeopathy Central Council Act, 1973 came into force.
17 June 1997	A single judge of the High Court directed the State Government to consider the issue of registration for ‘Paramparya Vaidyas’.
8 January 2003	The Division Bench of the High Court dismissed the petitions filed by the appellants.
13 April 2018	The Supreme Court dismissed the appeals, upholding the High Court’s decision.

Course of Proceedings

The ‘Paramparya Vaidyas’ initially filed petitions in the High Court of Kerala, challenging the requirement for registration under the Travancore-Cochin Medical Practitioners Act, 1953. A single judge of the High Court, considering an affidavit from the State Government, directed the government to consider the issue of registration. However, the Division Bench of the High Court dismissed the petitions on 08 January 2003, leading to the current appeals before the Supreme Court.

Legal Framework

The Supreme Court examined several key legal provisions.

✓ Section 17 of the Indian Medicine Central Council Act, 1970 (IMCC Act): This section specifies the qualifications required for enrollment on a State Register of Indian Medicine. It also restricts the practice of Indian medicine to those who possess recognized qualifications and are registered, with certain exceptions.

“17. Rights of persons possessing qualifications included in Second, Third and Fourth Schedules to be enrolled. – (1) Subject to the other provisions contained in this Act, any medical qualification included in the Second, Third or Fourth Schedule shall be sufficient qualification for enrolment on any State Register of Indian Medicine. (2) Save as provided in section 28, no person other than a practitioner of Indian medicine who possesses a recognized medical qualification and is enrolled on a State Register or the Central Register of Indian Medicine,- (a) shall hold office as Vaid, Siddha, Hakim or [physician or Amchi or] any other office (by whatever designation called) in Government or in any institution maintained by a local or other authority; (b) shall practice Indian medicine in any State; (c) shall be entitled to sign or authenticate a medical or fitness certificate or any other certificate required by any law to be signed or authenticated by a duly qualified medical practitioner; (d) shall be entitled to give evidence at any inquest or in any court of law as an expert under section 45 of the Indian Evidence Act, 1872 (1 of 1872), on any matter relating to Indian Medicine. (3) Nothing contained in sub-section (2) shall affect,- (a) the right of a practitioner of Indian medicine enrolled on a State Register of Indian Medicine to practise Indian medicine in any State merely on the ground that, on the commencement of this Act, he does not possess a recognized medical qualification; (b) the privileges (including the right to practice any system of medicine) conferred by or under any law relating to registration of practitioners of Indian medicine for the time being in force in any State on a practitioner of Indian medicine enrolled on a State Register of Indian Medicine; (c) the right of a person to practise Indian medicine in a State in which, on the commencement of this Act, a State Register of Indian Medicine is not maintained if, on such commencement, he has been practicing Indian medicine for not less than five years; (d) the rights conferred by or under the Indian Medical Council Act, 1956 (102 of 1956)[including the right to practice medicine as defined in clause (f) of section 2 of the said Act], on persons possessing any qualifications included in the Schedules to the said Act. (4) Any person who acts in contravention of any provision of sub-section (2) shall be punished with imprisonment for a term which may extend to one year, or with fine which may extend to one thousand rupees, or with both.”

✓ Sections 23 and 38 of the Travancore-Cochin Medical Practitioners Act, 1953: Section 23 outlines the eligibility criteria for registration, including possessing recognized qualifications or having practiced for at least five years before April 1, 1953. Section 38 prohibits individuals not registered under the Act from practicing modern, homeopathic, or ayurvedic medicine.

“23.Eligibility for registration.- (1) Subject to the provisions of sub-sections(2) and (5).- (i)every holder of a recognised qualification and every practitioner holding appointment under the Government at the commencement of this Act, and (ii)every person who, within the period of one year or such other longer period as may be fixed by the Government from the date on which this Act come into force, proves to the satisfaction of the appropriate council that he has been in regular practice as a practitioner for a period of not less than five years preceding the first day of April, 1953. shall be eligible for registration under this Act: Provided however that no practitioner shall be registered under clause (ii) after the expiration of one year, or such other longer period as may be fixed by the Government, from the date on which this Act come into force. (2)Applicants for registration under clause (ii) of sub-section (1) shall produce a certificate in Form I as set forth in the schedule. The certificate shall be from an officer of the Revenue Department not below the rank of a Tahsildar or any other person authorized by the Government in this behalf. (3)The Government may, after consulting the appropriate council, permit the registration of any person who shall furnish to such council proof that he is possessed of a medication degree, diploma or certificate of any University, medical school or college approved by such council other than those mentioned in the Schedule. (4)The Government shall have power to direct the registration of any practitioner who, at the time of registration under this section, is employed in a hospital, asylum, infirmary, clinic surgery, lying in hospital, sanatorium, nursing home, dispensary, vaidyasala or dharmasala managed by any corporate body: Provided however that no such practitioner shall be registered under this sub-section after the expiration of one year, or such other longer period as may be fixed by the Government, from the date on which this Act comes into force. (5)No person shall be eligible for registration under sub-section (1), sub-section (3), or sub-section (4) if he is subject to any of the disqualifications mentioned in clause (a) to (e) of Section 7. 38. Persons not registered under this Act, etc., not to practice.- No person other than (i) a registered practitioner or (ii) a practitioner whose name is entered in the list of practitioners published under Section 30 or (iii) a practitioner whose name is entered in the list mentioned in Section 25 shall practice or hold himself out, whether directly or by implication, as practising modern medicine, homoeopathic medicine or ayurvedic medicine, siddha medicine or unani tibbi and no person who is not a registered practitioner of any such medicine shall practise any other medicine unless he is also a registered practitioner of that medicine: Provided that the Government may, by notification in the Gazette, direct that this section shall not apply to any person or class or persons or to any specified area in the State where none of the three classes of practitioners mentioned above carries on medical practice: Provided further that this section shall not apply to a practitioner eligible for registration under this Act who, after having filed the application for registration, is awaiting the decision of the appropriate council or of the Government in case of appeal: Provided also that this section shall not apply to a practitioner eligible for registration under this Act until the period prescribed for application under Section 23 expires.”

The legislative authority to regulate these systems of medicine is derived from Entry 26, List III of the Seventh Schedule of the Constitution of India.

Arguments

The appellants, representing the ‘Paramparya Vaidyas’, argued that they have been practicing traditional medicine for generations, acquiring knowledge and expertise through heredity and practice. They contended that:

✓ Their methods are based on custom and tradition, where knowledge is passed down within families.
✓ They prepare medicines specific to each patient’s needs, with no side effects.
✓ The Travancore-Cochin Medical Practitioners Act, 1953, unfairly prevents them from practicing without registration.
✓ They have applied for licenses, but the State Government has not taken positive steps and instead has harassed them.
✓ The High Court erred by focusing solely on recognized qualifications, ignoring their traditional practices.
✓ Any mandatory prohibition must be express and unambiguous, and the prohibition under Section 38 of the Travancore-Cochin Medical Practitioners Act, 1953, should be understood in the context of Section 32 of the Act.

The State of Kerala countered that:

✓ Many individuals are practicing Indian systems of medicine without qualifications or registration, violating Section 38 of the Travancore-Cochin Medical Practitioners Act, 1953 and Section 17 of the IMCC Act.
✓ This unauthorized practice poses a threat to public health, with some practitioners producing and misusing alcoholic preparations.
✓ The IMCC Act does not recognize traditional practitioners, and there are no exemptions for practicing without qualifications, except for those who practiced for five years before the Act’s commencement, in states without a State Register.
✓ Many practitioners register associations to issue bogus certificates, lacking genuine tradition or qualifications.

Submissions Table

Main Submission	Appellants’ Sub-Submissions	Respondents’ Sub-Submissions
Traditional Practice	Knowledge acquired through heredity and practice. Custom of passing knowledge within families. Medicines prepared specifically for each patient.	Practice without qualifications is a threat to public health. Misuse of alcoholic preparations. Many lack genuine tradition, using bogus certificates.
Legal Restrictions	Travancore-Cochin Medical Practitioners Act, 1953, unfairly prevents practice without registration. Section 38 prohibition should be understood in context of Section 32. Applied for licenses, but no action taken.	Violation of Section 38 of the Travancore-Cochin Medical Practitioners Act, 1953 and Section 17 of the IMCC Act. No exemptions for practicing without qualifications. IMCC Act does not recognize traditional practitioners.
High Court’s Approach	High Court erred by focusing solely on recognized qualifications.	High Court was right in dismissing the petitions.

Issues Framed by the Supreme Court

The sole issue before the Supreme Court was:

Whether the persons who do not fulfill the prescribed qualification and are not duly registered under the relevant Statute, be permitted to practice as ‘Paramparya Vaidyas’?

Treatment of the Issue by the Court

Issue	Court’s Treatment
Whether unqualified persons can practice as ‘Paramparya Vaidyas’?	The Court held that persons without prescribed qualifications and registration cannot practice as ‘Paramparya Vaidyas’. The Court emphasized the need for regulated medical practices to protect public health and safety.

Authorities

The Supreme Court considered the following authorities:

✓ Dr. Mukhtiar Chand and Others vs. State of Punjab and Others (1998) 7 SCC 579: This case discussed the various systems of medicine in India and the statutes regulating them. It clarified the distinction between State and Central registers and the qualifications required for practice. It also highlighted the protection given to those who were already enrolled in State Registers or had been practicing for five years before the enactment of the IMCC Act. (Supreme Court of India)

✓ Dr. A.K. Sabhapathy vs. State of Kerala and Others 1992 Supp (3) SCC 147: This case examined Section 38 of the Travancore-Cochin Medical Practitioners Act, 1953, and Sections 15 and 21 of the Indian Medical Council Act, 1956. It held that only those with recognized medical qualifications could practice allopathic medicine, and that any state law allowing otherwise was repugnant to the central law. (Supreme Court of India)

✓ Delhi Pradesh Registered Medical Practitioners vs. Director of Health, Delhi Administration Services and Others (1997) 11 SCC 687: This case clarified that Section 17(3) of the IMCC Act protects those who were registered or had the right to be registered before the Act’s enactment, not those who acquired degrees later. (Supreme Court of India)

✓ Dr. Sarwan Singh Dardi vs. State of Punjab and Others AIR 1987 P&H 81: This case held that only qualified and registered practitioners could practice modern or Indian medicine. (Punjab & Haryana High Court)

✓ Ishaq Husain Razvi vs. State of U.P. and Others AIR 1993 All. 283: This case emphasized that practitioners must possess the requisite recognized qualifications for registration. (Allahabad High Court)

✓ Section 17 of the Indian Medicine Central Council Act, 1970: This provision outlines the rights of persons possessing qualifications included in the Second, Third, and Fourth Schedules to be enrolled in a State Register of Indian Medicine.

✓ Sections 23 and 38 of the Travancore-Cochin Medical Practitioners Act, 1953: These provisions specify the eligibility for registration and prohibit unregistered individuals from practicing medicine.

Authority Table

Authority	Court’s Treatment
Dr. Mukhtiar Chand and Others vs. State of Punjab and Others (1998) 7 SCC 579 (Supreme Court of India)	Followed for the distinction between State and Central registers and the qualifications required for practice.
Dr. A.K. Sabhapathy vs. State of Kerala and Others 1992 Supp (3) SCC 147 (Supreme Court of India)	Followed for the principle that only those with recognized medical qualifications can practice allopathic medicine.
Delhi Pradesh Registered Medical Practitioners vs. Director of Health, Delhi Administration Services and Others (1997) 11 SCC 687 (Supreme Court of India)	Followed for the interpretation of Section 17(3) of the IMCC Act.
Dr. Sarwan Singh Dardi vs. State of Punjab and Others AIR 1987 P&H 81 (Punjab & Haryana High Court)	Followed for the principle that only qualified and registered practitioners can practice medicine.
Ishaq Husain Razvi vs. State of U.P. and Others AIR 1993 All. 283 (Allahabad High Court)	Followed for the requirement of possessing recognized qualifications for registration.
Section 17 of the Indian Medicine Central Council Act, 1970	Considered for outlining the rights of persons with qualifications for enrollment in State Registers.
Sections 23 and 38 of the Travancore-Cochin Medical Practitioners Act, 1953	Considered for eligibility for registration and prohibition of unregistered individuals from practicing medicine.

Judgment

The Supreme Court upheld the High Court’s decision, ruling against the appellants. The Court emphasized the importance of qualifications and registration for practicing medicine, citing the need to protect public health.

Treatment of Submissions

Submission	Court’s Treatment
Appellants’ claim of traditional practice and hereditary knowledge	The Court acknowledged the traditional practices but emphasized that such practices cannot override the need for qualifications and registration, as mandated by law.
Appellants’ argument that the Travancore-Cochin Medical Practitioners Act, 1953, unfairly prevents them from practicing.	The Court held that the Act is valid and necessary to regulate medical practice and protect public health.
Appellants’ contention that the High Court erred by focusing solely on recognized qualifications.	The Court disagreed, stating that the High Court correctly focused on the legal requirements for medical practice.
Respondents’ argument that unqualified practice poses a threat to public health.	The Court agreed, highlighting the dangers of allowing unqualified individuals to practice medicine.
Respondents’ assertion that the IMCC Act does not recognize traditional practitioners.	The Court affirmed that the IMCC Act requires recognized qualifications and registration, with limited exceptions.

Treatment of Authorities

The Supreme Court relied on the following authorities:

✓ Dr. Mukhtiar Chand and Others vs. State of Punjab and Others [CITATION]: The Court used this case to understand the regulatory framework for different medical systems and to emphasize the need for registration.

✓ Dr. A.K. Sabhapathy vs. State of Kerala and Others [CITATION]: The Court cited this case to reinforce that only those with recognized qualifications can practice medicine.

✓ Delhi Pradesh Registered Medical Practitioners vs. Director of Health, Delhi Administration Services and Others [CITATION]: This authority was used to interpret the exceptions under Section 17(3) of the IMCC Act.

✓ Dr. Sarwan Singh Dardi vs. State of Punjab and Others [CITATION] and Ishaq Husain Razvi vs. State of U.P. and Others [CITATION]: These cases were used to support the principle that only qualified and registered practitioners can practice medicine.

What weighed in the mind of the Court?

The Supreme Court was primarily concerned with upholding the regulatory framework for medical practice to ensure public health and safety. The Court emphasized the following:

✓ The need for qualified medical practitioners to provide safe and effective treatment.
✓ The dangers of allowing unqualified individuals to practice medicine, potentially causing harm to patients.
✓ The importance of adhering to the provisions of the Travancore-Cochin Medical Practitioners Act, 1953 and the IMCC Act, which require registration and recognized qualifications.
✓ The limited exceptions under the IMCC Act, which did not apply to the appellants.
✓ The fact that the appellants did not possess the requisite qualifications or registration.

Sentiment Analysis Table

Reason	Percentage
Public Health and Safety	40%
Regulatory Compliance	30%
Lack of Qualifications	20%
Limited Exceptions	10%

Ratio Table

Category	Percentage
Fact (Consideration of factual aspects of the case)	30%
Law (Consideration of legal provisions and precedents)	70%

Logical Reasoning

Issue: Can unqualified persons practice as ‘Paramparya Vaidyas’?

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Consideration: Travancore-Cochin Medical Practitioners Act, 1953 & IMCC Act, 1970

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Legal Requirement: Registration and recognized qualifications are mandatory

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Appellants’ Situation: Lack of requisite qualifications and registration

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Exception Check: Exceptions under IMCC Act do not apply

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Conclusion: Unqualified persons cannot practice as ‘Paramparya Vaidyas’

The Court considered the appellants’ arguments about traditional practices and hereditary knowledge but rejected them, stating that these cannot override the legal requirements for qualifications and registration. The Court emphasized that allowing unqualified individuals to practice medicine would endanger public health.

The Court’s decision was based on a thorough analysis of the relevant laws and precedents, with a strong emphasis on the need to protect public health through regulated medical practices.

The Court quoted the following from the judgment:

“The capacity to diagnose the disease would depend upon the fact as to whether the practitioner had the necessary professional skill to do so. Acquisition of professional skill is again a regulated subject and the measure thereof is the possession of a prescribed Diploma or Degree awarded by a recognized Institution.”

“Even a person who has acquired the prescribed Diploma or Degree from a recognized institution would not be entitled to practice medicine unless he is so registered under the provisions of the IMCC Act.”

“The regulatory measures on the exercise of this right both with regard to the standard of professional qualifications and professional conduct have been applied keeping in view not only the right of the medical practitioners but also the right to life and proper health care of persons who need medical care and treatment.”

There were no dissenting opinions, and the bench consisted of two judges.

Key Takeaways

✓ Individuals practicing traditional medicine must possess recognized qualifications and be registered under the relevant statutes.
✓ Traditional practices and hereditary knowledge do not exempt practitioners from legal requirements for medical practice.
✓ The State has the authority to regulate medical practices to protect public health and safety.
✓ The judgment reinforces the importance of standardized medical qualifications and registration.
✓ This decision may impact other traditional medicine practitioners who do not possess formal qualifications.

Directions

No specific directions were given by the Supreme Court in this judgment.

Development of Law

The ratio decidendi of this case is that individuals practicing traditional medicine must possess recognized qualifications and be registered under the relevant statutes to ensure public health and safety. This judgment reinforces the existing legal framework and does not introduce any new legal principles but clarifies the application of existing laws to traditional medicine practitioners.

Conclusion

The Supreme Court dismissed the appeals, upholding the High Court’s decision that individuals practicing traditional medicine must possess recognized qualifications and be registered under the relevant statutes. The Court emphasized that traditional practices and hereditary knowledge do not exempt practitioners from these legal requirements. This judgment underscores the importance of regulated medical practices to protect public health and safety.

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Source: Kerala Ayurveda Paramparya Vaidya Forum vs. State of Kerala