Sanchayita Lahkar

The High Court of Kerala Single Bench of Justice Harisankar V. Menon upheld the constitutional validity of the Kerala Clinical Establishments (Registration and Regulation) Act, 2018, and the corresponding Rules. The Court dismissed a series of writ petitions challenging the said legislation, stating that the Act does not violate any constitutional provisions. The petitions, which included challenges from various associations of private hospitals, clinics, laboratories, and dental practitioners, were primarily cantered around claims of unconstitutionality, arbitrariness, and excessive delegation of power to statutory authorities. The Court, however, determined that none of these grounds justified judicial intervention.

The Court explicitly held that "the challenge against the constitutionality of the Act in question is, therefore, only to be rejected, and I do so." Additionally, the Court affirmed the State Government's legislative competence under Article 246(3) read with Entry 6 of List II of the Seventh Schedule. It also confirmed that the statute's provisions—such as mandatory display of fee rates, emergency treatment obligations, and inspection mechanisms—do not suffer from vagueness or breach of privacy. The Court further clarified that the Kerala enactment operates independently of the Central Clinical Establishments Act, 2010, which does not preclude Kerala from enacting its own legislation.

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The writ petitions were filed by various stakeholders within the healthcare sector in Kerala, including the Kerala Private Hospitals Association, Indian Medical Association (Kerala Branch), Indian Dental Association (Kerala), Kerala Private Clinics Association, Medical Laboratory Owners Association, and individual medical and dental practitioners. These petitioners sought to challenge multiple provisions of the Kerala Clinical Establishments (Registration and Regulation) Act, 2018 ("the Act") and the corresponding Kerala Clinical Establishments (Registration and Regulation) Rules ("the Rules").

The primary contention was that Sections 16(2), 26, 39(2) and (3), and 47 of the Act, along with several related Rules, were vague, arbitrary, and unconstitutional. Section 39(2), for instance, mandates the display of "fee rate" and "package rate," terms that petitioners claimed were undefined and prone to misuse by authorities. Similarly, Section 47 mandates clinical establishments to provide treatment during emergencies. Petitioners argued that such provisions were impractical, especially in rural settings.

The Kerala Private Hospitals Association objected to the data submission requirements under Form 2A, arguing that they exceed the scope of Section 4, particularly in the absence of a notification under Section 4(1)(g). The Association also contended that Section 26, which prescribes penalties, lacks clarity on what constitutes a contravention.

The Indian Medical Association, through Senior Counsel K.I. Mayankutty Mather, did not challenge the validity of the enactment itself but argued that Sections 14(3)(a) and (c) give unbridled powers to the Authority to suspend or cancel registration citing "imminent danger to public health," a term that the petitioners claimed was undefined. The IMA also expressed concerns about the practicality of the emergency transport requirement under Section 47(1) and the lack of clarity around "fee rate" and "package rate."

The Indian Dental Association, represented by Senior Counsel George Poonthottam, raised objections to the inclusion of a representative from a "welfare organisation of the patients" in the State Council and Executive Committee under Sections 3 and 8 of the Act. It was argued that this inclusion compromised the expert nature of these bodies. The Association also objected to Section 19(11), which makes inspection results public, and Section 19(14), which permits registration cancellation for failure to meet standards without corrective opportunity.

Further objections were raised regarding Section 25(1)(b), which permits registration cancellation, and Section 27(3), which allows evidence from third parties. Sections 37 and 38, enabling inspection and search, were challenged for allegedly violating patient and employee privacy. The Association also argued that medical colleges were arbitrarily excluded from the definition of clinical establishments under Section 2(c)(i).

Individual dental practitioners (WP(C) No.41738 of 2023) contended that the Central Clinical Establishments Act, 2010, enacted under Article 252, barred the Kerala legislature from enacting a separate law. They argued that dentistry, which was not included under the Central Act, was wrongly covered under the Kerala Act through Section 2(j). The Dentists Act, 1948, was cited as the governing statute for dental practice.

The State, represented by State Attorney Shri Manoj Kumar, argued that the Act was enacted under Entry 6 of List II and was thus within the legislative competence of the State. He stated that the Act promotes transparency, accountability, and public health. He also cited the Supreme Court’s order dated 27.02.2024 in W.P. (C) No.648 of 2020, which required the display of treatment costs. He refuted claims of privacy invasion, noting that many hospitals already publish staff and treatment details online. The State further argued that the Act had been widely complied with, as most establishments had already obtained registration.

Advocate Ajit Joy, representing intervenors, submitted that the Act ensures transparency and public welfare. He cited examples of hospitals already displaying treatment rates and referenced the Kerala High Court’s Division Bench judgement in WP(C) No.10659 of 2021 to support the Act’s legality.

The Court began its examination by observing, "Right to health is integral to right to life," referencing Article 21 of the Constitution and Article 47 of the Directive Principles of State Policy. Justice Menon stated, "Government has constitutional obligation to provide health facilities." Citing State of Punjab and Others v. Mohinder Singh Chawla, the Court stated the State’s duty to ensure health standards.

On the issue of legislative competence, the Court noted, "It is under Article 246(3) that the State Legislature is empowered to enact laws, with specific reference to the matters enumerated in List II in the Seventh Schedule of the Constitution." The Court confirmed that Entry 6—"Public health and sanitation; hospitals and dispensaries"—empowers the State to legislate on the subject. It further stated, "The Constitution nowhere provides that...the remaining States are bound to adopt the said legislation or are not empowered to legislate under Article 246 independently."

Addressing the contention that the Act violates Article 14 by granting unbridled powers to authorities, the Court cited State of A.P. v. McDowell & Co., stating, "A law made by the Parliament or the Legislature can be struck down by Courts on two grounds and two grounds alone, viz., (1) lack of legislative competence and (2) violation of any of the fundamental rights guaranteed in Part-III of the constitution."

Regarding the alleged arbitrariness of the provisions, the Court recorded, "An enactment cannot be struck down merely on account of the alleged unreasonableness/ arbitrariness." It also held, "Apart from the submission made to that effect, none of the petitioners has relied on any actual unreasonable actions/steps taken against them."

On Section 39 and the requirement to display fee and package rates, the Court observed, "The petitioners are not entitled to raise any challenge...since the petitioner in WP(C)No.1365 of 2019 has already published the details on its website." The Court referred to the Supreme Court’s order and the Division Bench judgement in Sabu P. Joseph (Adv.) v. State of Kerala which had upheld the same provision.

As for the inclusion of a representative from welfare organisations, the Court did not find this to breach the principles of the statute. On privacy concerns related to inspections, the Court noted, "The statute permits inspections under defined statutory guidelines and therefore cannot be termed as arbitrary."

On the argument regarding dentistry, the Court clarified, "Dentists are independently covered under the Dentists Act, 1948," but held that this does not preclude regulation under a broader clinical establishment’s framework. It concluded that the Kerala Act does not infringe upon the domain of the Central legislation.

The Court categorically stated, "The challenge against the constitutionality of the Act in question is, therefore, only to be rejected, and I do so." It upheld the entirety of the Kerala Clinical Establishments (Registration and Regulation) Act, 2018 and the Rules made thereunder. The Court also stated that, "Under Article 47 of the Constitution of India, it is the duty of the State to raise the standard of living and to improve public health."

Regarding the specific contentions raised under Sections 14, 16, 26, 39, and 47, the Court held that, "The mere 'possibility' of abuse/misuse of a statutory provision is not to be a guiding factor in considering the constitutionality of a statute." It further stated, "The cancellation of registration, etc., are after following due process of law."

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The Court further directed that, while the challenges against the constitutionality of the Act were rejected, liberty is granted to the petitioners to present the practical difficulties encountered by clinical establishments during the implementation of the Act and Rules before the Government.

It was specified that it is for the Government to consider these pointed out practical difficulties and to adopt such remedial measures as it deems fit, taking into account the totality of interests of both the clinical establishments and the beneficiaries of the statute

Subject to the afore liberty granted to the petitioners herein, these writ petitions would stand dismissed.

Advocates Representing the Parties:

For the Petitioners: Kurian George Kannathanam (Sr.), K.I. Mayankutty Mather (Sr.), George Poonthottam (Sr.), K.M. Sathyanatha Menon, R. Surendran, Nisha George, Kavery Varma M.M., Kavya Varma M.M., Ajit Joy, and others.

For the Respondents: Shri E.G. Gorden, Senior Government Pleader; Shri N. Manoj Kumar, State Attorney; Shri S. Kannan, Senior Government Pleader.

Case Title: Kerala Private Hospital Association and Another v State of Kerala and Others & Connected Cases

Neutral Citation: 2025: KER:44533

Case Number: WP(C) No.1365 of 2019 and connected cases

Bench: Justice Harisankar V. Menon