Overview The decision by a division bench of the Kerala High Court to uphold the validity of the Kerala Clinical Establishments (Registration and Regulations) Act 2018 (KCE Act) represents a significant victory for the Kerala government. The Act aims to introduce transparency and ethical standards within clinical practices through a regulatory framework. This initiative has faced strong resistance from the state's private health sector. Key Stakeholders and Their Concerns Kerala Private Hospital Association (KPHA) and Indian Medical Association (Kerala Chapter) [IMA] The KPHA and IMA , having lost their writ appeals against an earlier High Court single bench ruling, continue to express concerns. They argue that the implementation of the KCE Act could be detrimental to small and medium-sized hospitals in Kerala, potentially leading to their closure. Hussain Koya Thangal , president of the KPHA , stated, "We are not against the Act. But our concerns about the practical issues that stand in the way of its implementation have not been addressed... Small and medium hospitals, which provide affordable health care to people, will have to shut shop if the government insists on going ahead with the implementation of the Act." Key Provisions of the KCE Act Mandatory Registration: All clinical establishments must register. Minimum Standards: Establishments must maintain certain minimum standards based on their category. Transparency: Hospitals are required to openly display their rates for various procedures. Arguments Against the Act The KPHA and the IMA argued that the mandate to publish “type of service” and “package rates” under Sections 39(2) and 39(3) was vague, impractical, and prone to arbitrary interpretation, violating rights under Articles 14 and 19(1)(g) of the Constitution. They also maintained that the Act imposed unreasonable burdens on private hospitals. Concerns of Overburdening Small Hospitals Mr. Thangal highlighted the composition of the KPHA's membership: "We have 1,362 members, of whom only about 50 are super speciality hospitals. About 300 are medium hospitals with 100-200 beds. All the rest are hospitals with less than 50 beds... How can these hospitals take huge responsibilities such as stabilising accident victims and ensuring their safe transport?" The division bench clarified that small clinics are only expected to screen, stabilize within capacity, and ensure safe transfer. Fear of Persecution N. Sulphi , a member of IMA’s central working committee, expressed concerns about potential misuse of the Act: "Every death in a hospital is now alleged to be due to medical negligence by the public before an inquiry is conducted. We fear that the provisions of this Act will be used to persecute small hospitals and cancel their licence." Government's Perspective Sources at the Health department emphasized that the Act includes provisions for grievance redressal and legal recourse for clinical establishments. An official stated, "They have consistently created hurdles in the way of the implementation of the Act because they do not want any scrutiny on them... They fear that the implementation of the Act would open up all these to question. Or else why would they challenge even the simple act of registration under the Act?" Court's Observations The court clarified that the Act does not require hospitals to do a “clairvoyant pre-pricing of every possible clinical contingency.” It only requires the display of baseline tariffs for identifiable services and packages. The court further stated that the “practical difficulty in implementation cannot by itself destroy the validity of a law enacted in public interest.” It emphasized that the Act operationalizes constitutional duties through registration, standards, transparency, and enforceable minimum requirements for emergency care and stabilization. Conclusion Both the KPHA and the IMA have stated that they are not seeking confrontation with the government but wish for their concerns to be addressed through consultations.