In a landmark judgment reinforcing the “Right to Life” under Article 21, the High Court of Kerala has strictly mandated that no clinical establishment in the State shall deny initial life-saving aid to emergency patients on the ground of non-payment or lack of documentation.
While upholding the constitutional validity of the Kerala Clinical Establishments (Registration and Regulation) Act, 2018, the Division Bench comprising Justice Sushrut Arvind Dharmadhikari and Justice Syam Kumar V.M. issued stringent guidelines to ensure private hospitals comply with emergency care obligations. The Court dismissed the writ appeals filed by the Kerala Private Hospitals Association (KPHA) and the Indian Medical Association (IMA), declaring the contested provisions regarding emergency stabilization and rate transparency as intra vires and essential for public health.
The appeals (WA Nos. 1621/2025 and 1806/2025) challenged the judgment of a learned Single Judge dated June 23, 2025, which upheld the 2018 Act. The appellants specifically contested Section 47 of the Act, which imposes a duty on clinical establishments to provide emergency medical examination and stabilization. They argued this was impractical for smaller clinics.
Rejecting these contentions, the Division Bench held that the obligation to stabilize patients is “capacity-graded” but absolute in its prohibition against refusal of care. The Court ruled that the Act mirrors global standards like the WHO Emergency Care System Framework and the US EMTALA (Emergency Medical Treatment and Active Labor Act). The judgment concluded with the issuance of mandatory guidelines, explicitly stating that financial incapacity cannot be a bar to emergency treatment.
Background of the Case
The Kerala Private Hospitals Association and the Indian Medical Association approached the High Court challenging the validity of the Act and Rules, particularly Section 47 (Emergency Treatment) and Section 39 (Display of Rates). They contended that the requirements were vague, arbitrary, and violative of their fundamental rights under Articles 14 and 19(1)(g) of the Constitution.
The appellants argued that smaller institutions lack the staff and infrastructure to manage emergencies or arrange “safe transport” as mandated. They also challenged the requirement to publish “package rates,” citing the variability of medical treatment. The Single Judge had dismissed the initial writ petitions, leading to these intra-court appeals.
Arguments of the Parties
Appellants (KPHA & IMA):
- Impracticality of Section 47: Senior Advocate Sri. V.V. Asokan argued that the mandatory requirement for “safe transport” and emergency treatment is unworkable for smaller clinics.
- Vagueness of Rates: They submitted that “package rates” cannot be predicted with certainty as treatment varies per patient, making Section 39 arbitrary.
- Privacy Violations: The requirement to furnish detailed staff lists was opposed as a violation of privacy and a potential tool for “poaching” by competitors.
Respondent (State of Kerala):
- Public Safety: State Attorney Shri. N. Manoj Kumar argued that the Act is welfare legislation intended to safeguard patient safety and minimize medical errors.
- Global Standards: The State contended that the emergency care provisions align with international norms where stabilization is a primary duty.
- Transparency: It was argued that displaying rates is necessary to combat information asymmetry and allow patients to make informed choices.
Court’s Analysis: The Right to Emergency Care
The Division Bench provided a detailed analysis of the legal and ethical obligations of hospitals.
1. On Emergency Stabilization (Section 47) The Court emphasized that the “constitutional bedrock” of Article 21 subsumes the right to emergency medical care. Relying on the Supreme Court’s decision in Parmanand Katara v. Union of India, the Court observed:
“The minimum obligation is to provide lifesaving first aid and stabilization before referral or transfer… No refusal or delay is permitted due to inability to pay, lack of documents, or pending insurance/jurisdictional formalities.”
The Bench clarified that compliance is “capacity-graded.” A primary clinic is expected to provide first aid and airway management within its means, not high-end surgeries, but it cannot simply turn a patient away.
2. On Transparency (Section 39) Rejecting the argument that “package rates” are vague, the Court held:
“Transparency combats information asymmetry and guards against exploitative charging… The Act does not require clairvoyant pre-pricing of every possible clinical contingency; it mandates good faith baseline tariffs.”
3. On Hardship Claims Addressing the appellants’ claims of practical difficulty, the Court cited the maxim Dura Lex Sed Lex (“the law is harsh, but it is the law”), stating that hardship to a group cannot invalidate a law enacted in the public interest.
Decision
The Court dismissed the appeals and upheld the validity of the Act.
“We hold that the validity of the impugned Sections 16, 39, and 47 of the Kerala Clinical Establishments (Registration and Regulation) Act, 2018… is intra vires and requires no interference.”
Mandatory Guidelines Issued
To enforce the judgment effectively, the Court issued specific directions to be complied with immediately:
- No Refusal of Treatment:
“No establishment shall deny initial life-saving aid on the ground of non-payment of advance or lack of documents.” Every establishment must screen and stabilize emergency patients within its capacity and ensuring safe transfer. - Display of Rates: Hospitals must prominently display baseline and package rates in Malayalam and English at the reception and on their websites.
- Patient Information Brochure: A brochure detailing services, rates, and the grievance redressal mechanism must be provided to patients at admission.
- Discharge Records: Hospitals must hand over all investigation reports (ECG, X-ray, CT scan, etc.) to the patient along with the discharge summary.
- Strict Compliance Audit: The District Registering Authority has been directed to conduct verification audits within 60 days to ensure compliance.
The High Court ordered the judgment to be forwarded to the Chief Secretary and State Police Chief for strict enforcement, observing:
“Let this judgment serve not merely as a declaration of law but as a reaffirmation of the right to dignified, ethical, and equitable medical care.”
