http://JUDIS.NIC.IN SUPREME COURT OF INDIA Page 1 of 12  

PETITIONER: DR. A.K. SABHAPATHY

       Vs.

RESPONDENT: STATE OF KERALA AND ORS.

DATE OF JUDGMENT22/04/1992

BENCH: AGRAWAL, S.C. (J) BENCH: AGRAWAL, S.C. (J) FATHIMA BEEVI, M. (J)

CITATION:  1992 AIR 1310            1992 SCR  (2) 653  1992 SCC  Supl.  (3) 147 JT 1992 (3)    66  1992 SCALE  (1)843

ACT:        Constitution  of  India,  1950:  Article  254-Seventh Schedule-List-III-Entry  26-Medical Profession-Central  Law- State  law-Test  for determination  of  Repugnancy-What  is- Conditions  necessary for applicability of Article 254  dis- cussed. Doctrine of occupied filed.      Travancore-Cochin  Medical  Practitioners  Act,   1953: Section  38-First proviso-Medical  Practitioner-Practice  in allopathic system of medicine-Qualifications and  conditions for  registration-Power  of Government  to  grant  exemption from-First  proviso, to the extent it relates to  allopathic system of medicine, held inconsistent with and repugnant  to sections 15 and 21 of the Indian Medical Council Act, 1956.      Indian  Medical  Council  Act,  1956:  Section  2  (f)- Expression "Modern scientific medicine" refers to allopathic system of medicine-Object of the Act explained.

HEADNOTE:      Section    38   of   the   Travancore-Cochin    Medical Practitioners’ Act, 1953 provides that no person other  than a  registered medical practitioner or a  practitioner  whose name is entered in the list published under section 30 or in the  list published under Section 25 shall  practise  modern medicine,  homoepathic medicine, ayurvedic medicine,  siddha medicine or unani tibbi medicine.  It further provides  that no  person who is not a registered practitioner of any  such medicine shall practise any other medicine unless he is also registered  practitioner of that medicine. First proviso  to the  said  section empowers the State  Government  to  grant exemption from the application of the section by  publishing a  Notification in the official gazette. In exercise of  the power conferred by the said proviso the Government of Kerala issued  a  notification  dated May 4,  1977  directing  that Section  38  shall not aply to persons  holding  degree  and diploma from Kerala University in Integrated Medicine  (DAM) for practising                                                        654 modern  medicine in the State. By an order  dated  September 28, 1978 Government of Kerala also ordered that the  Diploma in Medicine and Surgery (DMS) awarded by Government of Bihar

http://JUDIS.NIC.IN SUPREME COURT OF INDIA Page 2 of 12  

will  be held at par with the integrated DAM of Kerala  Uni- versity  and  by its notification dated April 13,  1981  the Government  directed  that  section 38 shall  not  apply  to holders of DMS awarded by Government of Bihar.      The appellant challenged the validity of first  proviso to  section 38 and the Notifications dated May 4,  1977  and April 13, 1981 issued there-under as well as the order dated 28th September 1978 on the ground that the first proviso  to Section  38 of the Travancore-Cochin Medical  Practitioners’ Act,  1953, a State Act, was void under Article 254  of  the Constitution  because it was repugnant to  and  inconsistent with  section 15 of the Indian Medical Council Act, 1956,  a Central Act.      The  High Court of Kerala did not go into the  validity of notification dated May 4, 1977 but it upheld the validity of the first rpoviso and the order dated September 28,  1978 as well as the notification dated April 13, 1981 by  holding (a) that the Central Act does not lay down any qualification for  registration  and all that section 15 says  is  that  a person  whose name is not seen in the State  register  shall not  practise medicine; (b) the proviso to section  38  does not  in  terms say that a person whose name is  not  on  the rolls  of  the  State register in one  system  can  practise another system and it only exempts practitioners who want to practise one system without being in the concerned list from the  operation of section 38; (c) that neither  the  Central Act nor the State Act contains any provision which prohibits a person possessing the requisite qualification to  practise two  systems from getting enrolled on two State rolls and  a practitioner can be a registered practitioner in two  regis- ters  and  the Central Act does not place an  embargo  on  a State from recognising qualifications for the purpose of two systems;  (d) that the definition of medicine  contained  in section  2(f)  of  the Central Act would  not  involve  both Homoepathic  and indigenous system of medicine and that  the Central ACt concern itself only with the allopathic medicine and  the modern system contemplated by it is the  allopathic medicine.  Against  the judgment of the  Kerala  High  Court appeal was filed in this court.      Allowing the appeal in part, this court,                                                        655 HELD:  1. In order that Article 254(1) of  the  Constitution may  apply,  two  conditions must  be  fulfilled.   Firstly, provisions  of the Provincial law and those of  the  Central legislation  must  both be in respect of a matter  which  is enumerated  in the Concurrent List, and secondly, they  must be  repugnant  to each other.  It is only  when  both  these reguirements are satisfied that the Provincial law will,  to the extent of the repugnancy, become void. [661 B-C]      A.  S.  Krishna  v. State of Madras,  [1957]  SCR  399, Hoechst Pharmaceuticals Ltd. and Anr. etc. v. State of Bihar and Ors., [1983] 3 SCR 130, referred to.      2.  In the instant case the Central Act as well as  the State  Act  are  both laws made in respect  of  the  medical profession  which  is a matter relating to Entry 26  of  the Concurrent  List.  The field of operation of the  State  Act covers  all  the systems of  medicine,  namely,  allopathic, ayurvedic,   siddha,  unani  and  homoepathic   systems   of medicine.    Moreover   it   deals   with   recognition   of qualifications  required for registration of a person  as  a medical  practitioner  in  these  systems,  conditions   for registration  of  medical practitioners and  maintenance  of register  of practitioners for each system and  constitution of   separate  councils  for  modern  medicine   homeopathic medicine and indigenous medicine.  [661 E, 665 C-D]

http://JUDIS.NIC.IN SUPREME COURT OF INDIA Page 3 of 12  

    As compared to the State ACt, the field of operation of the  Central  Act is restricted and it is  confined  in  its application  to  modern  scientific  medicine,  namely,  the allopathic  system of medicine only, wherein also  it  deals with recognition of medical qualifications which may entitle a person to be registered as a medical practitioner, consti- tution of the Medical Council of India to advise the Central Government  in  the matter of recognition or  withdrawal  of recognition  of  medical qualifications,  to  prescribe  the minimum standards of medical education required for granting recognised medical qualifications by Universities or medical institutions in India and to appoint inspectors and visitors for inspection of any medical institution, college or hospi- tal.  But the Central Act  does not deal with the  registra- tion of medical practitioners in the States and it  proceeds on the basis that the said registration and the  maintenance of State Medical Register is to be governed by the law  made by the State. It cannot, therefore, be said that the Central Act  lays down an exhaustive code in respect of the  subject matter dealt with by the State ACt. [665 E-H]                                                   656      2.1 However it can be said that the Central Act and the State  Act, to a limited extent occupy the same field,  viz, recognition of medical qualifications which are required for a  person to be registered as a medical practitioner in  the allopathic  system  of medicine. Both  the  enactments  make provision for recognition of such qualifications granted  by the Universities or medical institutions. [665 H, 666 A]      Deep  Chand v. State of Uttar Pradesh and Ors.,  [1959] suppl. 2 SCR 8, relied on.      M.  Karunanidhi  v. Union of India,  [1979]  3SCR  254, referred to.      3. The High Court erred in holding that the Central ACt does  not lay down the qualifications for registration of  a medical  practitioner.  The provisions of  the  Central  Act contemplate that a person can practise in allopathic  system of  medicine  in  a  state or in  the  country  only  if  he possesses  a recognised medical qualification. Permitting  a person   who  does  not  possess  the   recognised   medical qualification in the allopathic system of medicine would  be in  direct conflict with the provisions of the Central  Act. [668 A, 668 C]      4. The first  proviso to Section 38 of the  Travancore- Cochin  Medical  Practitioners’ Act, 1953 in so  far  as  it empowers the State Government to permit a person to practise allopathic  system of medicine even though he does not  pos- sess  the recognised medical qualifications for that  system of medicine is inconsistent with the provisions of  Sections 15  and 21 read with Sections 11-14 of the Central Act.  The said  proviso suffers from the vice of repugnancy in so  far as  it  covers persons who want to practise  the  Allopathic system of medicine and is void to the extent of such  repug- nancy. Practitioners in allopathic system of medicine  must, therefore,  be excluded from the scope of the first  proviso and  it  must be confined in its application to  systems  of medicines other than the Allopathic system of medicine.                                               [668 C-E]      4.1.  The  notification dated April  13,  1981,  issued under the first proviso to Section 38, which enables holders of DMS diploma to practise modern medicine cannot be  upheld and  is  set aside.  However the order dated  September  20, 1978 treating the DMS diploma awarded by Government of Bihar at  par with Integrated DAM of the University of Kerala  for the  purpose of continuing in profession only has  not  been issued under the

http://JUDIS.NIC.IN SUPREME COURT OF INDIA Page 4 of 12  

                                                        657 first proviso to Section 38 of the State Act and it does not entitle the holders of DMS diploma to get themselves  regis- tered  as medical practitioner in modern medicine and  prac- tise modern medicine. Consequently, it does not suffer  from the same infirmity as the notification dated April 13, 1981. [668 G-H, 669 A-B]

JUDGMENT:      CIVIL APPELLATE JURISDICTION : Civil Appeal No. 3847 of 1983.      From the Judgment dated 14.10.1982 of the  Kerala  High court in O.P. No.3064 of 1981 C.      M.A. Firoz for the Appellant.      J.   Ramamurthy,  T.T.  Kunhikannan,  R.  Mohan,   M.K. Namboodry and  K.R. Nambiar [N.P.] for the Respondents.      The Judgment of the Court was delivered by      S.  C.  AGRAWAL,  J. This appeal by  special  leave  is directed  against the judgment of the High Court  of  Kerala dated  October 14, 1982. It raises the question relating  to the  validity  of  the first proviso to Section  38  of  the Tranvancore-Cochin   Medical   Practitioners’   Act,    1953 (hereinafter  referred to as ’the State Act’) and the  order dated  September 28, 1978 and notification dated  April  13, 1981 issued by the Government of Kerala.           Section 38 of the State Act reads as under:          "38.  Persons  not registered under this  Act  etc.          not  to  practise:-  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 practise or  hold  himself  out,          whether  directly or by implication  as  practising          modern    medicine,   homoepathic   medicine,    or          ayurvedic   medicine,  siddha  medicine   or   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                                                        658          or class of 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  practitioner eligible  for  registration          under this  Act who, after  having filed the appli-          cation  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          applications under Section 23 expires".      The  University of Kerala awards a degree as well as  a diploma in Integrated Medicine known as DAM. By notification dated  May 4, 1977 issued by the Government of Kerala  under the  first  proviso  to Section 38,  it  was  directed  that Section 38 of the Act shall not apply to the degree  holders of  DAM  and  diploma holders of DAM  in  practising  modern

http://JUDIS.NIC.IN SUPREME COURT OF INDIA Page 5 of 12  

medicine  in the State. The Government of Bihar through  the Bihar  State Board of Homoepathic Medicine awards a  Diploma in Medicine and Surgery called DMS. By order dated September 28,  1978,  the Government of Kerala ordered that  the  said diploma  (DMS)  awarded by the Government of Bihar  will  be held in par with the integrated DAM of Kerala University for purpose of continuing in the profession only. The holders of DMS  approached  the Government with a request to  issue  of notification  similar to notification dated May 4,  1977  to enable  them to practise Modern Medicine.  The said  request was earlier rejected by the Government but ultimately it was acceded  and a notification dated April 13, 1981 was  issued by  the Government of Kerala in exercise of the  power  con- ferred  by the first proviso to Section 38 of the State  ACt whereby  it was directed that Section 38 shall not apply  to holders  of the DMS awarded by the Government of Bihar.  The aforesaid notifications dated May 4, 1977 and April 13, 1981 and  order dated September 28, 1978 were challenged  by  the appellant  before the High Court of Kerala by filing a  Writ Petition under Article 226 of the Constitution. In the  said Writ  Petition it was submitted by the appellant that  after the  enactment  of  the Indian  Medical  Council  Act,  1956 (hereinafter  referred to as ‘the Central Act’), by  Parlia- ment the first proviso to Section 38 of the State Act, being repugnant and inconsistent with the provisions of Section 15 of the Central Act, has been rendered                                                        659 void  and ineffective and the impugned notifications  having been  issued in exercise of the power conferred by the  said proviso  are also void and ineffective. The validity of  the first  proviso  to  Section 38 of the  State  Act  was  also challenged  by the appellant on the ground that it does  not contain  any guidelines for exercise of the power  conferred on the State Government and since it confers arbitrary power on the State Government it is violative of the provisions of Article 14 of the Constitution.      The  said  Writ  Petition was contested  by  the  State Government.  On  behalf  of  the  State  Government  it  was submitted  that  since  DAM of Kerala  University  had  been permitted  practice of modern medicine, the  Government  did not  see any reason why the holders of DMS of Bihar  Govern- ment should not practice and that the order dated  September 28,  1978  was passed by the Government  after  consultation with the University of Kerala and the Director of Indigenous Systems of Medicine and that due consideration was given  by the  Government  to the allopathic subjects  taught  in  the Bihar  DMS course. As regards the notification dated May  4, 1977 relating to DAM diploma holders and DAM diploma holders of  Kerala University, it was submitted that  the  challenge was highly belated.      The  High  Court  did  not  go  into  the  validity  of notification dated May 4, 1977 relating to DAM degree  hold- ers  and DAM diploma holders for the reason that no one  who would be affected by the invalidation of the said  notifica- tion was before the Court and in absence of any such  person being  impleaded  as a party to the Writ  Petition,  it  was neither  permissible nor lawful for the Court to  adjudicate upon  the said question. While considering the  validity  of the other two notifications relating to DMS Diploma  holders of  Bihar,  the High Court examined the  provisions  of  the first  proviso to Section 38 in the light of the  provisions contained in  Section 15 of the Central Act.  The High Court rejected the contention urged on behalf of the State Govern- ment  that the definition of medicine contained  in  Section 2(f)  of the Central Act would take in both Homoepathic  and

http://JUDIS.NIC.IN SUPREME COURT OF INDIA Page 6 of 12  

indigenous systems of medicine and held that the Central Act concerns itself with the allopathic medicine and the  modern system  that is contemplated by it is the  allopathic  medi- cine.  After  examining the enactments the  High  Court  has observed  that  the State Act and the Central Act  are  both covered  by Entry 26 in List III of the schedule VII to  the Constitution.  The  High Court,  therefore,  considered  the question  whether  the first proviso to Section  38  of  the State Act was repugnant to Section 15 of the                                                        660 Central  Act  in the light of the  provisions  contained  in Article  254 of the Constitution.  The High Court  has  held that the Central Act does not lay down any qualification for registration  and all that Section 15 says is that a  person whose  name  is  not seen in the State  register  shall  not practise medicine. The High Court has also pointed out  that the  proviso  to  Section 38 does not in terms  say  that  a person whose name is not on the rolls of the State  register in one system can practise another system. According to  the High  Court the proviso only exempts practitioners who  want to  practice one system without being in the concerned  list from the operation of Section 38. The High Court was of  the view that neither the Central Act nor the State Act contains any  provision  which prohibits a person who  satisfies  the authorities that he possesses the requisite qualification to practise  two  systems from getting enrolled  on  two  State rolls and a practitioner can be a registered practitioner in two registers and the Central Act does not place an  embargo on  a State from recognising qualifications for the  purpose of  two  systems, due regard being given to  the  course  of study  and  subjects taught, for such qualification  and  if that  is possible, nothing prevents a State Government  from permitting  a practitioner to be on two rolls. Although  the High Court found some repugnancy between the Central Act and the  State Act, it was of the view that the  repugnancy  was not  one that was absolutely irreconcilable. The High  Court negatived the challenge to the validity of the first proviso to Section 38 of the State Act on the ground to violation of Article  14  on  the view that the power  conferred  by  the proviso vests in the State Government which is a  sufficient safeguard  against  arbitrary exercise of power.  Since  the validity  of the first proviso, Section 38 of the State  Act was  upheld  the notification dated April  13,  1981  issued under the said proviso was also upheld as valid by the  High Court.      The  appellant is assailing the validity of  the  first proviso  to  Section 38 of the State Act on  the  ground  of repugnancy  under Article 254 (1) of the Constitution  which provides as under:           "254.   Inconsistency   between   laws   made   by           Parliament  and laws made by the  Legislatures  of          States -(1)  if any provision of a law made by  the          Legislature of a state is  repugnant to any  provi-          sion  of a law made by Parliament which  Parliament          is  competent to enact, or to any provision  of  an          existing  law  with respect of one of  the  matters          enumerated in the Concurrent                                                          661           List,  then, subject to the provisions  of  clause           (2),  the law made by Parliament, ,whether  passed           before or after the law made by the Legislature of           such  State, or, as the case may be, the  existing           law,  shall  prevail  and  the  law  made  by  the           Legislature  of the State shall, to the extent  of           the repugnancy, be void".

http://JUDIS.NIC.IN SUPREME COURT OF INDIA Page 7 of 12  

    In order that Article 254(1) may apply, two  conditions must be fulfilled:           "(1)  The  provisions of the  Provincial  law  and          those  of the Central legislation must both  be  in          respect  of  a matter which is  enumerated  in  the          Concurrent   List, and (2) they must  be  repugnant          to  each  other.   It  is  only  when  both   these          requirements are satisfied that the Provincial  law          will,  to  the  extent of  the  repugnancy,  become          void".           A.S.  Krishna v. State of Madras, [1957]  SCR  399           Hoechst  Pharmaceuticals  Ltd. & Another  etc.  v.           State  of Bihar & Others, [1983] 3 SCR 130.      In  the  instant case the Central Act as  well  as  the State  Act  are  both laws made in respect  of  the  medical profession  which  is a matter relating to Entry 26  of  the Concurrent List. The question is : Are the provisions of the first  proviso to Section 38 of the State Act  repugnant  to any provision of the Central Act? This question will have to be answered by applying the tests of repugnancy laid down by this Court. In Deep Chand v. The State of Uttar Pradesh  and Ors.,  [1959] Suppl. 2 SCR 8, this Court has laid down  that repugnancy  between two statutes may be ascertained  on  the bases of the following principles:           (1)  Whether there is direct conflict between  the           two provisions;           (2)  Whether  Parliament intended to lay  down  an           exhaustive  code in respect of the subject  matter           replacing the Act of the State Legislature; and           (3) Whether the law made by Parliament and the law           made  by  the State Legislature  occupy  the  same           field". (P.43)                                                         662      After considering the various decisions construing  the provisions  of Article 254 this Court in M.  Karunanidhi  v. Union  of  India,  [1979] 3 SCR 254,  the  Court  laid  down following propositions:           "1.  That  in  order to  decide  the  question  of           repugnancy   it  must  be  shown  that   the   two           enactments contain inconsistent and irreconcilable           provisions, so that they cannot stand together  or           operate in the same field.           2.  That  there can be no  repeal  by  implication           unless  the inconsistency appears on the  fact  of           the two statutes.           3. That where the two statutes occupy a particular           field,  there is room or possibility of  both  the           statutes  operating  in  the  same  field  without           coming   into  collision  with  each   other,   no           repugnancy results.           4.  That  where there is no  inconsistency  but  a           statute  occupying the same field seeks to  create           distinct  and  separate offences, no  question  of           repugnancy  arises and both the statutes  continue           to operate in the same field". [P.278]      Keeping  in view these principles, we will examine  the provisions of the State Act and the Central Act to ascertain the field of operation of the two enactments.      As  indicated  in the Preamble the State Act is  a  law relating to medical practitioners generally in the State  of Travancore-Cochin  (now Kerala) and it has been  enacted  to regulate   the  qualifications  and  to  provide   for   the registration of the practitioners of modern medicine, homoe- pathic  medicine  and  indigenous medicine with  a  view  to encourage  the spread of such medicines. In Clause  (f)  the

http://JUDIS.NIC.IN SUPREME COURT OF INDIA Page 8 of 12  

expression  "modern medicine" is defined to mean  the  allo- pathic  system of medicine. Clause (g) of Section 2  defines "practitioner" to mean any person ordinarily engaged in  the practice  of  modern medicine or  homoeopathic  medicine  or indigenous  medicine  as  the case may  be.  The  expression "qualified  practitioner" has been defined in clause (i)  to mean a qualification enumerated in the Schedule. The expres- sion  "registered practitioner" has been defined  in  Clause (i)  of Section 2 to mean a practitioner whose name  is  for the  time  being entered in a register.  Under  Clause  (k), "register" means the                                                          663 Register of practitioners maintained under this Act. Section 3  makes  provisions for  establishment,  incorporation  and constitution  of Council of Modern Medicine, the Council  of Homoeopathic  Medicine and the Counsel of  Indigenous  Medi- cine. Section 19 provides for appointment of a Registrar for each  council and under Section 20(1) it is the duty of  the Registrar  to  keep the registers. Section 20(2)  lays  down that there shall be separate registers for modern  medicine, homoeopathic  medicine, ayurvedic medicine, siddha  medicine and  unani-tibbi medicine. Section 23 lays down  the  condi- tions of eligibility for registration of a practitioner  and every  holder  of a recognised  qualification  is  eligible. Sections 28 and 29 make provision for removal of the name of a  person from the register of practitioners. Section  31(1) imposes a prohibition that no registered practitioner, other than a qualified registered practitioner who has not  under- gone a course of practical training in surgery or obstetrics under modern medicine to the satisfaction of that  appropri- ate  council, shall practise surgery or obstetrics.  Section 47 empowers the State Government to alter the list of recog- nised qualifications mentioned in the Schedule to the Act on the basis of the report of the appropriate Council. It would thus be seen that the State Act governs the practitioners in the  various systems of medicine prevalent in the  State  by establishing  separate councils for each system to  regulate the registration of such practitioners and also by prescrib- ing  the qualifications which shall be recognised  for  such registration.      The  Central Act has been enacted to  provide  for  the reconstitution  of  the  Medical Council of  India  and  the maintenance  of medical register for India and  for  matters connected therewith. The expression "medicine" is defined in Clause  (f) of Section 2 to mean modern scientific  medicine in  all  its branches including surgery and  obstetrics  but excluding veterinary medicine and surgery. In Clause (h) the expression  "recognised  medical  qualification"  has   been defined  to mean any of the medical qualifications  included in  the Schedules. "State Medical Council" has been  defined in  Clause (j) to mean a medical council  constituted  under any law for the time being in force in any state  regulating the  registration of practitioners of medicine.  Clause  (k) defines   "State  Medical  Register"  to  mean  a   register maintained under any law for the time being in force in  any State regulating registration of practitioners of  medicine. Section  3  provides  for the constitution  of  the  Medical Council of India Sections 11 to 14 deal with recognition  of medical qualifications granted by universities or medical                                                        664 institutions  in  India as well as by  medical  institutions outside  India. Section 15 enables a person  possessing  the medical  qualifications  included  in  the  Schedule  to  be enrolled  on any State Medical Register and it  prohibits  a person  other  than  a medical practitioner  enrolled  on  a

http://JUDIS.NIC.IN SUPREME COURT OF INDIA Page 9 of 12  

State Medical Register to practise medicine in any State.      Section 16 prescribes that every university or  medical institution   in  India  which  grants  recognised   medical qualification  shall furnish such information as the  Indian Medical  Council  may from time to time require  as  to  the course of study and examinations to be undergone in order to obtain  such  qualification, as to the ages  at  which  such course  of  study  and  examinations  are  required  to   be undergone and such qualification is conferred and  generally as  to  the  requisites for  obtaining  such  qualification. Section   17  provides  for  the  appointment   of   medical inspectors  for  inspection  of  any  medical   institution, college,   hospital  or  other  institution  where   medical education is given. Under Section 18 the Medical Council  of India has been empowered to appoint visitors to inspect  any medical  institution, college hospital or other  institution where  medical education is given or attend any  examination held  by  any  university or  medical  institution  for  the purpose   of  granting  recognised  medical   qualification. Section  19  provides  for withdrawal of  recognition  of  a medical qualification by the Central Government on the basis of  the representation by the Medical Council. Section  19-A empowers  the  Medical  Council of India  to  prescribe  the minimum   standards  for  medical  education  required   for granting   recognised   medical   qualifications   by    the universities or medical institutions in India. Section  20-A empowers  the  Medical  Council of India  to  prescribe  the standards  of professional conduct and etiquette and a  code of  ethics  for   medical practitioners.  Section  21  makes provision for maintaining a register of medical  practition- ers  known as the Indian Medical Register, which shall  con- tain  the  names of all persons who are for the  time  being enrolled  on any State Medical Register and who possess  any of  the  recognised medical  qualifications.  Section  34(1) provides for removal of the name of a person from the  India Medical Register if his name has been removed from the State Medical  Register in pursuance of any power conferred by  or under  any law relating to registration of  medical  practi- tioners for the time being in force in any state. Section 27 provides that every person whose name is for the time  being borne  on  the  Indian Medical Register  shall  be  entitled according  to  his qualification to practise  as  a  medical practitioner in any part of India.                                                        665      The  High Court, in our opinion, has rightly held  that the expression ’modern scientific medicine’ in Section  2(f) of the Central Act refers to the Allopathic system of  medi- cine  and that the provisions of the Central Act  have  been made  in relation  to medical practitioners  practising  the said  system.  This view finds support from  the  fact  that after  the  enactment  of the Central  Act,  Parliament  has enacted  the  Indian Medicine Central Council Act,  1970  in relation to the system of Indian medicine commonly known  as Ayurveda, Siddha and Unani and the Homeopathy Central  Coun- cil Act, 1973 in relation to homoepathic system of  medicine wherin provisions similar to those contained in the  Central Act have been made in relation to the said systems of  medi- cine.      From the provisions of the State Act, noticed  earlier, it  is evident that the field of operation of the State  Act covers  all  the systems of  medicine,  namely,  allopathic, ayurvedic, siddha, unani and homoepathic system of medicine. Moreover   the   State  Act  deals   with   recognition   of qualifications  required for registration of a person  as  a medical  practitioner  in  these  systems,  conditions   for

http://JUDIS.NIC.IN SUPREME COURT OF INDIA Page 10 of 12  

registration  of  medical practitioners and  maintenance  of register   of   practitioners  for  each  system   and   the constitution  of  separate  councils  for  modern  medicine, homoepathic medicine and indigenous medicine. As compared to the State Act, the field of operation of the Central Act  is restricted  and it is confined in its application to  modern scientific  medicine,  namely,  the  allopathic  system   of medicine  only,  wherein also it deals with  recognition  of medical  qualifications  which may entitle a  person  to  be registered  as a medical practitioner, constitution  of  the Medical Council of India to advise the Central Government in the  matter of recognition or withdrawal of  recognition  of medical  qualifications, to prescribe the minimum  standards of medical education required for granting recognised  medi- cal  qualifications by universities or medical  institutions in India and to appoint inspectors and visitors for  inspec- tion  of  any medical institution, college or  hospital.  It also  provides for maintaining the Indian  Medical  Register and for enrolment of a person possessing recognised  medical qualification  in  the said register and for  removal  of  a person from the said register. The Central Act does not deal with the registration of medical practitioners in the States and it proceeds on the basis that the said registration  and the maintenance of State Medical Register is to be  governed by the law made by the State. It cannot, therefore, be  said that the Central Act lays down an exhaustive code in respect of  the subject matter dealt with by the State Act. It  can, however,                                                        666 be said that the Central Act and the State Act, to a limited extent  occupy the same field, viz., recognition of  medical qualifications  which  are  required  for  a  person  to  be registered  as  a  medical practitioner  in  the  allopathic system  of medicine. Both the enactments make provision  for recognition   of   such  qualifications   granted   by   the universities  or  medical institutions. The  third  test  of repugnancy  laid  down  in Deep  Chand’s  case  (supra)  is, therefore,  satisfied. Since the grievance of the  appellant is confined to the first proviso to section 38 of the  State Act,  we would examine whether the provisions of  the  First Proviso  to  Section 38 of the state Act,  are  inconsistent with any of the provisions of the central Act and whether it is possible to reconcile the provisions of the First Proviso to  Section 38 of the State Act with the provisions  of  the Central Act. The main part of Section 38 prohibits a  person other than those mentioned in the three categories specified therein,  namely,  (i) a registered practitioner or  (ii)  a practitioner  whose  name is entered in the  list  published under  Section  30  or (iii) a practitioner  whose  name  is entered  in the list published under Section 25 to  practise or  to hold himself out, Whether by directly or by  implica- tion,  as practising modern medicine, homoepathic  medicine, ayurvedic medicine, siddha medicine or unani-tibbi  medicine and it further lays down that no person who is not a  regis- tered practitioner of such medicine shall practice any other medicine unless he is also a registered practitioner in that medicine.  In other words, the main part of Section  38  in- sists  upon compliance with the requirements of  the  provi- sions of the State Act prescribing the conditions for regis- tration  as a medical practitioner which includes holding  a recognised  qualification, i.e., a qualification  enumerated in the schedule to the State Act, in respect of a particular system of medicine in which he wishes to practise. The first proviso  to Section 38 enables the State Government to  dis- pense  with the requirements of the main part of Section  38

http://JUDIS.NIC.IN SUPREME COURT OF INDIA Page 11 of 12  

in relation to any person or class of persons or in relation to  any specified area in the State where none of the  three classes of practitioners mentioned above carries on  medical practice. As a result a person can be permitted to  practise as  a medical practitioner even though he does  not  possess the  recognised  qualifications which are  necessary  for  a person  to  be  registered as a medical  practitioner  in  a particular  system of medicine. This provision in so far  as it  relates to the allopathic system of medicine, runs  con- trary to the provisions of the Central Act. Under S.11(1) of the  Central Act Medical qualifications granted by any  uni- versity  or medical institution in India which are  included in the First                                                        667 Schedule  of the said Act alone are the  recognised  medical qualifications and under Section 11(2) a medical  qualifica- tion  granted  by any university or medical  institution  in India  which  is not included in the First Schedule  can  be included in the said Schedule by the Central Government by a notification  in the Official Gazette after  consulting  the Medical  Council of India. Similar provisions are  contained in Section 12 in relation to medical qualifications  granted by  medical  institutions outside India in  connection  with which there is a scheme of reciprocity which  qualifications are included in the Second Schedule and Section 13  relating to medical qualifications granted by medical institutions in India  or outside India which are included in Part I and  II of the Third Schedule. Section 14 contains a special  provi- sion  empowering the Central Government  after  consultation with  the  Medical Council of India to give  recognition  to medical  qualifications granted by medical  institutions  in any  country outside India in respect of which a  scheme  of reciprocity  for the recognition of such medical  qualifica- tion is not in force. Section 15(1) entitles a person having recognised  medical  qualification under the Act to  be  en- rolled  in  any state medical register. Under  sub-s.(2)  of section  15  no  person other than  a  medical  practitioner enrolled on a State medical register shall practise medicine in any State. The object underlying these provisions in  the Central Act is that a person possessing a recognised medical qualification alone is entitled to be registered as a  medi- cal  practitioner  and it is the  Central  Government  alone which  can declare a particular medical qualification  as  a recognised  medical  qualification in  accordance  with  the provisions  contained in Section 11 to 14 of the Act.  More- over the Central Act, in Section 19-A, empowers the  Medical Council  of  India  to prescribe the  minimum  standards  of medical education required for granting  recognised  medical qualifications  by universities or medical  institutions  in India.  Section 16, 17 and 18 confer powers on  the  Medical Council of India to keep an eye on the imparting of  medical education  by the universities and medical  institutions  in India  and to appoint inspectors and visitors for that  pur- pose. Section 19 enables the Central Government to  withdraw the  recognition to a medical qualification on the basis  of the  representation by the Medical Council of  India.  These provisions  indicate  that in enacting the Central  Act  the intention  of  Parliament was to ensure  that  only  persons having adequate knowledge of the allopathic system of  medi- cine are able to practise medical profession.                                                        668      We are, therefore, unable to agree with the view of the High  Court  that  the Central Act does  not  lay  down  the qualifications  for registration of a medical  practitioner. We  may  in this context refer to sub-s.(1)  of  Section  15

http://JUDIS.NIC.IN SUPREME COURT OF INDIA Page 12 of 12  

which postulates the holding of a recognised medical  quali- fication  by  a  person for being registered  in  the  State Medical Register so as to entitle to practise modern  scien- tific  medicine  in the state and sub-s.(1)  of  Section  21 which  provides  that the Indian Medical  Register  that  is required  to be maintained by the Medical Council  of  India shall contain the name of persons who are for the time being enrolled  in the State Medical Register and who possess  any of  the recognised medical qualifications. These  provisions contemplate that a person can practise in allopathic  system of medicine in a state or in the country only if he possess- es  a recognised medical qualification. Permitting a  person who does not possess the recognised medical qualification in the  allopathic system of medicine would be in  direct  con- flict with the provisions of the Central Act. We are, there- fore,  of the view that the first proviso to Section  38  of the State Act in so far as it empowers the State  Government to permit a person to practise allopathic system of medicine even  though  he  does not possess  the  recognised  medical qualifications  for that system of medicine is  inconsistent with  the provisions of Section 15 & 21 read  with  Sections 11- 14 of the Central Act. The said proviso suffers from the vice  of repugnancy in so far as it covers persons who  want to  practice the Allopathic system of medicine  and is  void to the extent of such repugnancy. Practitioners in allopath- ic system of medicine  must, therefore, be excluded from the scope  of the first proviso and it must be confined  in  its application to systems of medicines other than the Allopath- ic  system of medicine. We, however, wish to make  it  clear that  we  have not considered the impact of  the  provisions contained in the Indian  medicine Central Council Act,  1970 and the Homoeopathy Central Council Act, 1973 on the  provi- sions of the said proviso to Section 38 of the State Act.      The  notification dated April 13, 1981 has been  issued under  the first proviso to Section 38 and in express  terms it enables holders of DMS diploma of Government of Bihar  to practise  modern medicine in the State of Kerala  and  makes them  eligible for registration as practitioners  in  modern medicine.  Since  the scope of the first  proviso  has  been restricted  to  exclude the system of modern  medicine,  the said notification cannot be                                                        669 upheld  and must be set aside. The same, however, cannot  be said  with regard to Order dated September 20, 1978  whereby the  DMS  diploma awarded by Government of Bihar  is  to  be treated  at  par with Integrated DAM of  the  University  of Kerala for the purpose of continuing in profession only. The said  order has not been issued under the first  proviso  to Section  38 of the State Act and it cannot be said  that  it entitles  the  holders  of DMS  diploma  to  get  themselves registered  as medical practitioners in modern medicine  and practise modern medicine. The said order dated September 20, 1978, does not suffer from the same infirmity as the notifi- cation dated April 13, 1981.      In  the  result,  the appeal  is  partly  allowed.  The judgment and order of the High Court of Kerala dated October 14,  1982  is set aside and the Writ Petition filed  by  the appellant  is  allowed to the extent that  the  notification (Ex.P8)  dated  April 13, 1981 is quashed. No  order  as  to costs. T.N.A                                  Appeal partly allowed