The Supreme Court has issued a notice to the Centre, states and Union Territories after hearing a plea which alleged mismanagement and exploitation of patients at private healthcare facilities.

Patients forced to choose between expensive private care and inadequate public health sector, says plea

Aneesha Mathur New DelhiJuly 27, 2021UPDATED: July 27, 2021 14:10 IST

Supreme Court of India.

The Supreme Court Tuesday sought the Centre’s response on a plea seeking directions for a uniform standard of healthcare for citizens in line with the Constitution by adopting the provisions of the Clinical Establishments Act, 2010.

The plea has also sought directions for operationalising all the provisions of the Act, as well as Clinical Establishment Rules, 2012 in order to ensure affordable and quality healthcare.

The Supreme Court on July 27 asked the Centre to respond to a petition that said fundamental right to health had taken a back seat as patients were forced to choose between expensive private care and an “inadequate” public health sector, especially during the COVID-19 pandemic.

A Bench led by Chief Justice of India N.V. Ramana issued notice on a petition filed jointly by Jan Swasthya Abhiyan, Patients’ Rights Campaign and Gopakumar K.M. for the proper implementation of the Clinical Establishments (Registration and Regulation) Act of 2010, the Clinical Establishment (Central Government) Rules of 2012 and the Patients’ Rights Charter.

“The regulation of standards in clinical establishments adopted as a national policy goal by Government of India nearly two decades ago is yet to be effectively implemented across the country. This is, therefore, a denial of the right to a dignified life. Minimum healthcare is assured under Articles 21, 41 and 47 of the Constitution and the international covenants,” the petition, represented by senior advocate Sanjay Parikh, said.

The petition said the Act and the Rules prescribed uniform conditions for registration at clinical establishments for treatment. This would include determined rates for medical care, procedures and services, standard treatment protocol as provided in Sections 11 and 12 of the Clinical Establishments Act 2010 read with Rule 9 of the Clinical Establishment Rules, 2012.

The hearing has come amid reports of skyrocketing private hospital charges for COVID-19 treatment. The petition said a grievance redressal mechanism should be made available to patients at district, State and national levels.

“This mechanism would look into grievances of the patients at different levels. This would include denial of patients’ rights by the hospitals/ clinics and failure to provide minimum care and facilities as provided under the Clinical Establishments Act and Rules,” the petition said.

The plea said that despite these laws, the “situation today is that more than 70% patient care is provided by the private sector and less than 30% patients use the public sector”.

The National Health Policies of 1983, 2002 and 2017 had promoted private health sector facilities, shifting focus away from the public health sector.

The plea in the Supreme Court referred to the inadequacies that existed in the public health care system, such as the lack of sufficient infrastructure, human resources, non-availability of medicines, inadequate public investment and “forced dependency on the private sector”.

NGO Jan Swasthya Abhiyan in a PIL raised several issues regarding lack of proper registration of private healthcare centres, inadequate medical facilities and trained personnel, and overcharging at such centers.

Senior advocate Sanjay Parikh, appearing for the NGO, also argued before the three-judge bench led by CJI Ramana, that “70 per cent of the healthcare in India is in private hands”.

“Standard guidelines for healthcare establishments, treatment protocol have to be there,” argued Parikh, who informed the court that the NGO had sent a representation to the government on the issue.

“NHRC and Ministry of Health set out a “patient’s charter” which has not yet been implemented. Only 11 states had adopted the registration resolution,” he added.

“There have been discussions in the Rajya Sabha about surgeries carried out in private hospitals. Health Ministry later said the Government has been receiving numerous complaints of gross overcharging, forcing patients to purchase hospital medicines and treatment at high prices,” Parikh said.


However, the CJI pointed out that there was a need to be practical. He said, “Question is we need to be practical. Registration rules are there. We expect the small clinical centers and labs to have qualified essential personnel including MBBS, MD doctors. It’s very burdensome to them. Ultimately they pass the burden to the patients,” commented the CJI.

After hearing a detailed argument, the bench issued a notice to the Centre and states and Union territories to respond to the issue.

“Let us hope the government will respond,” commented the CJI.

The NGO has sought several directions from the Apex court, such as-

  • Directions to operationalise all the provisions of the Clinical Establishments Act, 2010, and Clinical Establishment Rules, 2012, and among others, and
  • direct that the conditions for registration be notified and implemented to ensure affordable and quality healthcare.
  • To issue a Writ of Mandamus or any other writ or direction of like nature, to the Respondents to have a uniform standard of healthcare.
  • To declare that the Charter of Patients’ Rights notified by the NHRC, be implemented by all the States and Union Territories.
  • To issue a Writ of Mandamus or any other writ or direction of like nature, to direct that a grievance redressal mechanism be created for the patients at the district, state and national level till the lacunae in the CEA 2010 are filled by a suitable legislation.