SIDDHARTH DALMIA & ANR.versusUNION OF INDIA & ORS.

                  [2025] 4 S.C.R. 197 : 2025 INSC 351

                         Siddharth Dalmia & Anr.
                                    v.
                          Union of India & Ors.
                     (Writ Petition (C) No. 337 of 2018 )
                                 04 March 2025
    [Surya Kant* and Nongmeikapam Kotiswar Singh, JJ.]


                            Issue for Consideration
       In the instant Writ petition, purportedly filed in Public Interest, the
       Petitioner sought a direction to the private hospitals not to compel
       the patients to buy the medicines, etc. from the pharmacies
       recommended by them. The issues were (i) whether the affairs of
       the private hospitals, nursing homes, medical institutes, etc. with
       reference to the fixation of prices of drugs, equipment, or other
       accessories sold from the pharmacies run by them and/or with
       whom they have some commercial agreement, can be regulated
       through administrative or legislative measures? (ii) If so, what can
       be the extent of such measures? and (iii) What is the mechanism to
       enforce such measures and to whom such task can be entrusted.

                                   Headnotes†
       Constitution of India – Part IV; Seventh Schedule, List II –
       Problem of unreasonable charges and exploitation of patients
       in private hospitals – Not advisable for the Court to issue
       mandatory directions – Necessity to sensitize the State
       Governments – Direction to all the State Governments to take
       appropriate policy decisions:
       Held: The States have committed themselves to provide medical
       facilities to the people in furtherance of the duty and vision
       enshrined in Part IV of the Constitution – However, in proportion
       to the population of this country, the States have not been able to
       develop the requisite medical infrastructure to cater to the needs
       of all kinds of patients – The States have, therefore, facilitated
       and promoted private entities to come forward in the medical
       field – Not only the people, even the States look towards these
       private entities to provide basic and specialized medical facilities
       to the public at large – The subject of public health and sanitation,

* Author
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       hospitals, and dispensaries falls under List-II- the State List – It
       may not be advisable for this Court to issue mandatory directions
       which may hamper the growth of hospitals in the private sector;
       but parallelly, it is necessary to sensitize the State Governments re:
       the problem of unreasonable charges and exploitation of patients
       in private hospitals – Consequently, this Writ Petition is disposed
       of with a direction to all the State Governments to consider this
       issue and take appropriate policy decisions as they may deem fit.
       [Paras 13, 16 and 17]
       Constitution of India – Art. 21 – Right to life – Provision of
       medical facilities to one and all is an essential component of
       the right. [Para 13]

                                 Case Law Cited
       State of Punjab v. Ram Lubhaya Bagga [1998] 1 SCR 1120 :
       (1998) 4 SCC 117; Paschim Banga Khet Mazdoor Samity v. State
       of W.B. [1996] Supp. 2 SCR 331 : (1996) 4 SCC 37; Vincent
       Panikurlangara v. Union of India [1987] 2 SCR 468 : (1987) 2
       SCC 165; In Re : Section 6A of the Citizenship Act 1955 [2024]
       10 SCR 961: 2024 SCC OnLine SC 2880; Suman Kumar v. Union
       of India, 2023 SCC OnLine SC 1750; Transport & Dock Workers
       Union v. Mumbai Port Trust [2010] 14 SCR 873 : (2011) 2 SCC
       575; and Govt. of A.P. v. N. Subbarayudu [2008] 5 SCR 522 :
       (2008) 14 SCC 702 – referred to.

                                   List of Acts
       Constitution of India.

                                List of Keywords
       Public Interest; Private hospitals; Unreasonable charges and
       exploitation of patients in private hospitals; Mandatory directions;
       Sensitize the State Government; Policy decisions; Public health
       and sanitation, hospitals, and dispensaries; State List; Right to
       life; Medical facilities.

                                Case Arising From
       CIVIL ORIGINAL JURISDICTION: Writ Petition (Civil) No.
       337 of 2018
       (Under Article 32 of the Constitution of India)
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            Siddharth Dalmia & Anr. v. Union of India & Ors.


                         Appearances for Parties
     Advs. for the Respondents:
     Mohd Irshad, A.A.G., Lenin Singh Hijam, Adv. Gen./Sr. Adv., Anup
     Kumar Rattan, Advocate General, Sudarshan Lamba, Shailesh
     Madiyal, Devashish Bharukha, Vikrant Yadav, Akshay Amritanshu,
     Guntur Pramod Kumar, Ms. Prerna Singh, Dhruv Yadav, Ms. G.
     Indira, Abhimanyu Tewari, Ms. Eliza Bar, Samir Ali Khan, Pranjal
     Sharma, Anil Verma, Abhimanyu Jahmba, Varun Chugh, Krishna
     Kant Dubey, Vatsal Joshi, Ms. Indira Bhakar, Ms. Mrinal Elkar
     Mazumdar, Shreekant Neelappa Terdal, Ms. Ankita Sharma, Arjun
     D Singh, Ms. Poonam Dola, M/s. K J John And Co, Ms. Swati
     Ghildiyal, Ms. Neha Singh, Akshay Amritanshu, Ms. Drishti Saraf,
     Ms. Pragya Upadhyay, Ms. Mandakini Singh, Ms. Ashima Mandla,
     G.M. Kawoosa, Pashupathi Nath Razdan, Ms. Pallavi Langar,
     Sujeet Kumar Chaubey, Nishe Rajen Shonker, Mrs. Anu K Joy, Alim
     Anvar, Santhosh K, Anand Dilip Landge, Siddharth Dharmadhikari,
     Aaditya Aniruddha Pande, Pukhrambam Ramesh Kumar, Karun
     Sharma, Ms. Anupama Ngangom, Ms. Rajkumari Divyasana,
     Anando Mukherjee, Shwetank Singh, Ms. K. Enatoli Sema, Amit
     Kumar Singh, Ms. Chubalemla Chang, Prang Newmai, Aravindh S.,
     Akshay Gupta, Aadithya Aravindh, Siddhant Sharma, Milind Kumar,
     Sameer Abhyankar, Ms. Ripul Swati Kumari, Krishna Rastogi,
     Aakash Thakur, Ms. Yashika Sharma, Rahul Kumar, Sabarish
     Subramanian, Vishnu Unnikrishnan, Danish Saifi, Sravan Kumar
     Karanam, Aniket Singh, P. Geetanjali, Shuvodeep Roy, Saurabh
     Tripathi, Deepayan Dutta, Ankit Goel, Vikas Bansal, Harshit Singhal,
     Ms. Vanshaja Shukla, Ms. Anubha Dhulia, Siddhant Yadav, Avijit
     Mani Tripathi, T.K. Nayak, Marbiang Khongwir
     Petitioner-in-person.

                Judgment / Order of the Supreme Court

                                   Judgment

     Surya Kant, J.

1.   The instant Writ Petition, under Article 32 of the Constitution, has been
     filed purportedly in public interest. The petitioners seek to restrain
     private hospitals from compelling the patients to purchase medicines/
     devices/implants/consumables from the hospital pharmacies only,
     where they allegedly charge exorbitant rates, as compared to the
     notified market prices of those items.
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2.     The aforesaid relief has been sought in the backdrop of an unfortunate
       personal experience. The mother of petitioner No.1, who was the wife
       of petitioner No. 2, was diagnosed with breast cancer in July 2017.
       She underwent surgery, followed by six chemotherapies, 20 sessions
       of radio therapy, and 17 adjuvant chemotherapies. This course of
       treatment was continuing when the instant petition was filed in 2018.
       During the hearing, we were informed that, Smt. Neelam Dalmia,
       the patient recovered and fortunately, her condition has improved.
3.     The petitioners claim to have realized during her treatment that
       there is an organized system adopted by the private hospitals,
       nursing homes, health care institutions, etc. to fleece patients by
       compelling them and their attendants to buy medicines only from
       the pharmacies run by such hospitals or with whom they have some
       form of collaboration. It is claimed that the medicines/treatments etc.
       are sold by these pharmacies at highly inflated artificial prices, as
       compared to the MRP notified by the Competent Authority.
4.     The petitioners have further alleged that the Union of India and the
       States have failed to take regulatory and correctional measures as
       a result of which, the patients are being exploited throughout the
       country.
5.     Moreover, it is the case of the petitioners that the private hospitals do
       not disclose the prices/MRP of medicines, medical devices/implants,
       consumables, etc. to their patients, and in the absence of any price
       controlling or monitoring of the consumables which do not fall within
       the definition of “drugs”, under the Drugs and Cosmetics Act, 1940,
       the private hospitals, nursing homes, etc. take undue advantage of
       the fact that the patients or their attendants do not have much option
       but to purchase the items/medicines at inflated prices.
6.     The petitioners, accordingly, seek a direction to the private hospitals
       not to compel the patients to buy the medicines, etc. from the
       pharmacies recommended by them. They further seek a direction
       that the Union of India or the State Governments should formulate
       a policy to prevent this form of exploitation, which, if allowed
       to continue, would amount to the deprivation of their right to a
       healthy life guaranteed within the framework of Article 21 of the
       Constitution. It is the petitioners’ case that the States are obligated,
       in terms of Articles 38, 39 and 47 of our Constitution, where the
       Directive Principles of State Policy expect them to come forward
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            Siddharth Dalmia & Anr. v. Union of India & Ors.


     and introduce such regulatory measures as may be required to
     control this menace.
7.   On 14.05.2018, notice was issued in the petition, and in response
     thereto, counter affidavits have been filed by the States/Union
     Territories of Chandigarh, Orissa, Chhattisgarh, Arunachal Pradesh,
     Manipur, Andaman and Nicobar Islands, Uttar Pradesh, Bihar, Tamil
     Nadu, Kerala, Uttarakhand, Punjab, Haryana, Rajasthan, Nagaland,
     Himachal Pradesh, Jammu and Kashmir, and Gujarat.
8.   The Union of India, through the Ministry of Health and Family Welfare,
     has also filed a separate counter affidavit, inter alia, pointing out
     that the National Council for Clinical Establishments has issued
     minimum standards for the hospitals, including for pharmaceutical
     services, as per which, the availability of drugs, consumables, and
     medical services are ensured in hospitals. The Union of India has
     further taken a stand that there is no compulsion for the patients or
     their attendants to buy medicines from the hospital’s own pharmacy.
9.   The States and Union Territories, while questioning the locus of the
     petitioners have, inter alia, pointed out that Jan Aushadhi Kendras and
     Amrit Drug Stores have been set up in Government hospitals, which
     are being run by public sector undertakings, where all medicines are
     provided at subsidized rates. They rely upon the Drug Price Control
     Order, 2013, issued by the Central Government under the Essential
     Commodities Act, 1955 whereunder the prices of the essential drugs
     are fixed to ensure their availability at a reasonable rate. Like the
     Union of India, most of the States have also referred to the National
     Pharmaceutical Pricing Authority (NPPA), under the Ministry of
     Chemicals and Fertilizers, which, according to them, has the mandate
     to fix/revise the prices of controlled bulk drugs and formulations to
     enforce prices and availability of the medicines in the country.
10. We may hasten to add that most of the States have also highlighted
    State-run-schemes, which are meant to ensure the availability of
    drugs, consumables, and medical services to the patients and
    their attendants at affordable prices. Some States have introduced
    cashless treatment schemes, especially to provide medical facilities
    to specially-abled persons, widows, and BPL card-holders.
11. We have heard learned counsel for the petitioners as well the counsels
    for the Union of India and other States.
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12. The issues that fall for consideration are: (i) whether the affairs of
    the private hospitals, nursing homes, medical institutes, etc. with
    reference to the fixation of prices of drugs, equipment, or other
    accessories sold from the pharmacies run by them and/or with
    whom they have some commercial agreement, can be regulated
    through administrative or legislative measures? (ii) If so, what can
    be the extent of such measures? and (iii) What is the mechanism to
    enforce such measures and to whom such task can be entrusted?
13. There can be no doubt that the provision of medical facilities to one
    and all is an essential component of the right to life guaranteed
    under Article 21 of the Constitution.1 The States have, therefore,
    committed themselves to provide medical facilities to the people
    in furtherance of the duty and vision enshrined in Part IV of the
    Constitution. It is also a matter of record that in proportion to the
    population of this country, the States have not been able to develop
    the requisite medical infrastructure to cater to the needs of all kinds
    of patients. The States have, therefore, facilitated and promoted
    private entities to come forward in the medical field as a result of
    which, numerous renowned private hospitals, well-known for their
    specialties, and which are comparable to any other hospital around
    the globe, have been set up throughout the country. It, therefore,
    must be acknowledged that not only the people, even the States
    look towards these private entities to provide basic and specialized
    medical facilities to the public at large.
14. In this backdrop, would it be prudent for the Union of India or the
    States to introduce a policy which regulates each and every activity
    within the compound of these private hospitals? Will such a policy
    discourage persons to come forward and invest in the health industry
    throughout the country? Most importantly, why should the States not
    adopt such economic policies whereunder they ensure dedicated
    apportionments towards the development of basic infrastructure,
    including institutions for health services; and till such time the
    States are able to do so, whether stringent measures which would
    stall private entities from coming forward, should be allowed to be
    introduced?



1   State of Punjab v. Ram Lubhaya Bagga (1998) 4 SCC 117; Paschim Banga Khet Mazdoor Samity v.
    State of W.B. (1996) 4 SCC 37; Vincent Panikurlangara v. Union of India (1987) 2 SCC 165.
[2025] 4 S.C.R.                                                                               203

               Siddharth Dalmia & Anr. v. Union of India & Ors.


15. All these issues are undoubtedly of paramount public importance.
    It, however, seems to us that such issues primarily involve policy
    decisions, for which the policy-makers are the best equipped to take
    a holistic view and formulate the guidelines as may be required,2
    to safeguard the patients or their attendants from exploitation while
    simultaneously, ensuring that there is no discouragement and
    unreasonable restriction on private entities from entering the health
    sector.
16. It may be noticed that the subject of public health and sanitation,
    hospitals, and dispensaries falls under List-II – the State List – and,
    therefore, any such measure, as illustrated above, must be taken
    by the State Governments, keeping their local conditions in mind.
17. To sum up, it may not be advisable for this Court to issue mandatory
    directions which may hamper the growth of hospitals in the private
    sector; but parallelly, it is necessary to sensitize the State Governments
    re: the problem of unreasonable charges and exploitation of patients
    in private hospitals.
18. Consequently, we dispose of this Writ Petition with a direction to all
    the State Governments to consider this issue and take appropriate
    policy decisions as they may deem fit.
19. It is clarified that we have not expressed any opinion on the merits
    of the case. We have only briefly explained the plight of the public at
    large, who comprise a huge class of consumers of health services,
    alongwith the constitutional framework within which such policy
    decisions are required to be taken to redress their grievances.
20. As a result, the pending interlocutory applications, if any, also stand
    disposed of.

     Result of the case: Writ Petition disposed of.



     †
         Headnotes prepared by: Bibhuti Bhushan Bose



2   In Re : Section 6A of the Citizenship Act 1955, 2024 SCC OnLine SC 2880; Suman Kumar v. Union of
    India, 2023 SCC OnLine SC 1750; Transport & Dock Workers Union v. Mumbai Port Trust, (2011) 2 SCC
    575; Govt. of A.P. v. N. Subbarayudu, (2008) 14 SCC 702.