Patient Rights Under the National Medical Commission Act, 2019: A Critical Analysis of the Appellate Framework and the Need for Judicial and Legislative Intervention

Abstract

The National Medical Commission (NMC) Act, 2019, brought sweeping reforms by replacing the Indian Medical Council Act, 1956, and the Medical Council of India (MCI). While the Act was enacted to enhance access to quality healthcare and ensure ethical standards, it introduced a critical limitation: restricting the right of appeal in disciplinary matters to only aggrieved medical practitioners or professionals. This marks a sharp departure from the earlier framework, under which Regulation 8.8 of the 2002 Regulations expressly granted the right of appeal to “any person aggrieved,” including patients. This exclusion creates a discriminatory classification, undermines natural justice, and raises serious constitutional concerns under Articles 14 and 21. The paper argues that both judicial interpretation and legislative intervention are essential to restore patients’ rights and to ensure a fair, participatory, and effective grievance redressal system.

The Pre-NMC Era: A Patient-Centric Appellate Framework

For over sixty years, the Indian Medical Council (IMC) Act, 1956[ii], and the Regulations made under it, the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002, provided the legal framework for regulating medical professional conduct and disciplinary procedures in India. The Act created the Medical Council of India, empowered it to maintain uniform standards of medical education, recognize medical qualifications, and oversee the Indian Medical Register. The 2002 Regulations, on the other hand, codified the ethical duties of doctors, defined acts of professional misconduct, and laid down the procedure for inquiries and disciplinary action before State Medical Councils and the MCI. Together the Act read with the Regulations established a clear, two- tiered grievance redressal mechanism. A complainant, such as a patient or their family, could file a complaint of professional misconduct with the relevant State Medical Council. Following an inquiry by the State Medical Council, Regulation 8.8[iii], provided an explicit and crucial right of appeal: "any person aggrieved by the decision of the State Medical Council" could file an appeal with the Medical Council of India (MCI). This appellate right was a cornerstone of patient protection, giving them a statutory remedy and recognizing them as vital stakeholders in the disciplinary process.

The Shift to the NMC Act, 2019: A Critical Change in the Grievance Redressal Mechanism

The legal landscape underwent a seismic shift with the enactment of the National Medical Commission (NMC) Act, 2019, which repealed the IMC Act and abolished the MCI and, in its place, created the National Medical Commission, a new regulatory body. While the NMC Act was introduced with laudable objectives, including improving access to quality healthcare, ensuring ethical standards having an effective grievance redressal mechanism and for matters connected therewith or incidental thereto, it introduced a critical change in the right of appeal. The right to appeal a disciplinary decision, previously available to any aggrieved person, was explicitly restricted to only an aggrieved medical practitioner or professional. This change effectively removed the statutory right of appeal for a patient or their family.

Section 30(3) and 30(4)[iv] of the NMC Act explicitly restricts the right to appeal a State Medical Council's decision to the Ethics and Medical Registration Board (EMRB) to only an “aggrieved medical practitioner or professional.” This marks a major departure from the earlier legal framework. Under the new act a complainant who initiates the disciplinary process is no longer afforded a statutory right of appeal.

This stands in sharp contrast to the earlier regime, wherein Regulation 8.8 of the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002, expressly conferred a right of appeal upon ‘any person aggrieved.’ The difficulty is compounded by the fact that the NMC itself, through its notification dated 23 August 2023, has affirmed that the 2002 Regulations continue to remain in force, thereby creating an apparent inconsistency between the parent statute and the subordinate legislation.

The Constitutional Conundrum and Judicial Interpretation

This absence of an explicit provision in the NMC Act, 2019, that grants a patient or complainant the right to appeal a State Medical Council's decision presents a significant constitutional issue.

The legal implications of this change have been tested in several cases, where appeals filed by complainants to the National Medical Commission under the 2002 regulations were dismissed. The orders of the National Medical Commission came to be challenged in various petitions before the Hon`ble Delhi High Court. The Delhi High Court, in Surendra Kumar Dabas v. National Medical Commission of India[v] and Sunil Dhull v. National Medical Commission[vi], while dealing with the order of passed by National Medical Commission, upheld the NMC's stance, ruling that a non-medical practitioner's appeal is not maintainable under the new Act.

In its reasoning, the court in the Surendra Kumar Dabas (supra) case held that Section 30(4), Section 30(4) makes no provision for a complainant preferring a further appeal before the Commission against an order that may be passed by the Ethics and Medical Registration Board. Bearing in mind the fact that the trial of complaints and the adjudicatory process in respect thereof stands governed by Section 30 exclusively. Crucially, the court noted that it could not rule on the constitutionality of the provision because it had not been directly challenged by the petitioner. However, the court did not address the issue of an appeal by a complainant to the Ethics and Medical Registration Board under Section 30(3) of the Act. The issue of a patient’s or complainant's right to appeal under section 30(3) of the NMC Act, 2019 is also pending before the Supreme Court of India in the case of Suranjana Hazarika v. Union of India[vii] in which the core grievance is the denial of a forum for appeal under Section 30(3) of the NMC Act.

Constitutional Infringements and the Abrogation of Natural Justice

The grant of a right of appeal solely to a medical practitioner, while denying it to a non-medical complainant, creates an unreasonable and discriminatory classification. The NMC Act's provision creates a clear classification between two parties in a disciplinary proceeding: the accused medical professional, who is granted a statutory right to appeal, and the complainant, who is left without a corresponding remedy. This raises the fundamental question of whether this classification is arbitrary and violative of Article 14 of the Constitution, which guarantees equality before the law. The classification, based solely on professional status, appears to have no rational nexus to the legitimate objective of a disciplinary and appellate mechanism. The purpose is to ensure accountability and justice for all parties involved. NMC cannot simply ignore its own binding regulations. The NMC, as a creature of statute, is bound by its own rules and regulations which have statutory force.

Judicial Role in Balancing Patient Rights and Procedural Fairness

While legislative amendments are the most direct solution, the judiciary also has a vital role in interpreting the existing provisions of the NMC Act. Courts should not rely on a narrow, literal reading of Sections 30(3) and 30(4). Instead, they should give a wider interpretation to these provisions that considers the broader objectives of the Act and the rights of the parties involved, the provisions must be read in conjunction with Article 14 and 21 of the Constitution of India.

The NMC Act's preamble explicitly aims to ensure an "effective grievance redressal mechanism." A literal interpretation that bars patients from appealing directly contradicts this goal. The courts should interpret the provisions to include a patient's right to appeal, ensuring the mechanism remains effective and does not become a one-sided process.

The current framework creates a clear and arbitrary classification that discriminates against complainants solely based on their professional status. This classification lacks a "rational nexus" to the Act's purpose of ensuring justice for all parties. Courts should recognize this disparity and interpret the law to grant equal appellate rights to both the accused professional and the aggrieved complainant. The right to a fair hearing and access to justice are integral facets of Article 21. Denying a patient the right to appeal a potentially flawed quasi-judicial decision violates this fundamental right. Courts should interpret the Act to provide a meaningful and effective remedy, thereby upholding the principles of natural justice and ensuring no party is left without recourse.

By adopting a purposive and constitutionally sensitive interpretation, the judiciary can close the gap left by the present statutory scheme. Such an approach would not only give effect to the broader objectives of the NMC Act but also ensure that the disciplinary process remains balanced, participatory, and ultimately fair to all stakeholders in India’s healthcare system.”

The Legislature’s Role in Protecting Patient Rights

The current provisions of Sections 30(3) and 30(4) of the National Medical Commission (NMC) Act have created an unjust and discriminatory system that denies patients and their families the right to appeal a State Medical Council's decision. This exclusion undermines both fairness and accountability in the medical disciplinary process.

It is pertinent to mention here that the government itself has acknowledged this flaw. The Government of India, Ministry of Health & Family Welfare, through a notification dated 29th December 2022, has decided to amend the NMC Act, 2019. This proposed amendment specifically aims to provide a clear provision for patients, their relatives, or any complainant to file an appeal with the Ethics and Medical Registration Board (EMRB) or the National Medical Commission (NMC) against a decision of the State Medical Council. However, despite this stated intention, no formal legislative changes have been enacted. The proposed amendment is a significant admission by the government of the existing imbalance and the need to rectify it.

It is the Legislatures responsibility to correct this imbalance and to restore fairness, uphold constitutional principles, and ensure that the Act's framework aligns with its stated objectives. The amendments should expand the right to appeal from only "aggrieved medical practitioner or professional" to "any aggrieved person," thereby restoring the previous, more equitable framework. Such a step would bring back the more inclusive approach that existed under the earlier framework and ensure that patients are recognized as equal stakeholders in proceedings that directly concern them.

This reform is essential to uphold constitutional principles of equality and natural justice, and it is now for the legislature to act so that the NMC Act truly fulfils its stated objective of providing an effective and fair grievance redressal system.