IMA White Paper: Physiotherapists Cannot Use the Prefix “Dr”
Dr K K Aggarwal
Dr K K Aggarwal
The Rehabilitation Council of India Act, 1994 (hereinafter referred to as “RCI Act”) is enacted to provide for the constitution of the Rehabilitation Council of India for regulating the training of rehabilitation professions and the maintenance of a Central Rehabilitation Register and for matters connected therewith or incidental thereto.
According to Section 2(i)(n)(xvii) of RCI Act, the term “physiotherapist” means a Rehabilitation professional. Thus, the physiotherapists in India are regulated by the provisions of RCI Act and its Rules and Regulations and not by any other Act or law in India.
Section 13(2) of RCI Act mandates that no person other than a rehabilitation professional, who possesses a recognized rehabilitation qualification and is enrolled in the register shall practice as a rehabilitation professional anywhere in India. Thus for a physiotherapist to carry out his occupation as physiotherapist, it is mandatory that the physiotherapist should possess a recognised qualification as per the RCI Act and should also be registered as per the provisions of RCI Act with the Rehabilitation Council of India, or else as per section 13(3) the said physiotherapist without registration with Rehabilitation Council of India shall be punished with imprisonment for a term which may extend to one year or with fine which may extend to Rs.1,000/- or with both.
Thus, the physiotherapists are rehabilitation professionals who are registered with the Rehabilitation Council of India.
The Hon’ble Supreme Court of India, in the matter titled as “Poonam Verma versus Ashwin Patel, CA No. 8856/1994 dated 10.05.1996 has held that:
“A person who does not have knowledge of a particular System of Medicine but practices in that System is a Quack and a mere pretender to medical knowledge or skill, or to put it differently, a Charlatan.”
In view of the above landmark judgement, it is stated that the person who possesses recognized qualification / knowledge of a particular system of medicine is only authorized to practice in that particular system of medicine. If a person practices in any other system of medicine of which he does not possess recognized qualification / knowledge, then that person would be considered as a quack i.e., a mere pretender to medical knowledge or skill, or a charlatan.
There are three major systems of medicines in India i.e., (1) Allopathic or modern system of medicine, (2) Ayurvedic, Siddha or Unani Tibb system of medicine and (3) Homeopathic system of medicine. Different Central and state legislations, laws and Acts have been enacted for all the three systems of medicine. It is pertinent to mention herein that all the three systems of medicine do not allow crosspathy i.e., a person who has obtained a recognized qualification / knowledge of a particular system of medicine is only authorized to practice that particular system of medicine and not any other. Further, penal actions are also there if a person practices some other system of medicine of which he has not obtained a recognized qualification.
The persons who have recognised qualification as per the Indian Medical Council Act, 1956 and who are registered with the Indian Medical Council or State Medical Council as per the Indian Medical Council Act, 1956 are the persons who are allowed to practice modern system of medicine as per the Indian Medical Council Act, 1956.
Similarly, the persons who have recognised qualification as per the Indian Medicine Central Council Act, 1970 and who are registered with the Indian Medicine Central Council or the respective State Medicine Councils are the persons who are allowed to practice the medicine system of Ayurveda, Siddha or Unani.
Also, the persons who have recognised qualification as per the Homoeopathy Central Council Act and who are registered with the Homoeopathy Central Council or the respective State Councils are the persons who are allowed to practice the medicine system of Homoeopathy.
Accordingly, only the persons practising modern system of medicine or AYUSH are allowed to use “Dr.” before their name as they are the only persons who are termed as Doctors.
In view of the above, it is stated that the physiotherapist is not allowed to practice medicine and / or to prescribe drugs especially the Scheduled Drugs as mentioned in the Drugs and Cosmetics Act on their own as they do not possess recognised qualification as mentioned in Indian Medical Council Act, 1956, Indian Medicine Central Council Act and Homoeopathy Medicine Central Council Act. Also, they cannot claim themselves to be a specialist medical practitioner and by prefixing the word "Dr" with their name in their prescription. If the physiotherapists is doing the same then he is creating an impression on his patient that he is a medical consultant which is an offence in the eyes of law and the said person is a Quack as stated by the Hon’ble Supreme Court.
The Hon’ble Supreme Court in the matter titled as “Dr. Mukhtiar Chand versus The State of Punjab, 1998 (7) SCC 579,” has held that:
“Section 15(2)(b) of the 1956 Act prohibit all persons from practising modern scientific medicine in all its branches in any State except a medial practitioner enrolled on a State Medical Register. There are two types of registration as far as the State Medical Register is concerned. The first is under Section 25, provisional registration for the purposes of training in the approved institution and the second is registration under Section 15(1). The third category of registration is in the "Indian Medical Register" which the Council is enjoined to maintain under Section 21 for which recognised medical qualification is a prerequisite. The privileges of persons who are enrolled on the Indian Medical Register are mentioned in Section 27 and include the right to practise as a medical practitioner in any part of India. "State Medical Register" in contradistinction to "Indian Medical Register", is maintained by the State Medical Council which is not constituted under the 1956 Act but is constituted under any law for the time being in force in any State; so also a State Medical Register is maintained not under the 1956 Act but under any law for the time being in force in any State regulating the registration of practitioners of medicine. It is thus possible that in any State, the law relating to registration of practitioners of modern scientific medicine may enable a person to be enrolled on the basis of the qualifications other than the "recognised medical qualification" which is a prerequisite only for being enrolled on the Indian Medical Register but not for registration in a State Medical Register. Even under the 1956 Act, "recognised medical qualification" is sufficient for that purpose. That does not mean that it is indispensably essential. Persons holding "recognised medical qualification" cannot be denied registration in any State Medical Register, but the same cannot be insisted upon for registration in a State Medical Register. However, a person registered in a State Medical Register cannot be enrolled on the Indian Medical Register unless he possesses "recognised medical qualification." This follows from a combined reading of Sections 15(1), 21(1) and 23. So by virtue of such qualifications as prescribed in a State Act and on being registered in a State Medical Register, a person will be entitled to practise allopathic medicine under Section 15(2)(b) of the 1956 Act.”
Further, vide order dated 25.01.2001, the Medical Council of India in the complaint case against Dr. Mahavir Singh has held that:
“I am directed to state that for the purposes of practising Allopathy System of Medicine i.e. Modern Scientific System of Medicine, a person apart from fulfilling other requirements under the provisions of the Indian Medical Council Act, 1956, must possess a recognized medical qualification and be registered on the State Medical Register: Indian Medical Register under the provisions of the IMC Act, 1956. Since BAMS is not a recognized medical qualification under any of the schedules to the IMC Act, 1956, a person possessing that qualification cannot be permitted to practice Allopathy System of Medicine. Further, a person possessing only BAMS and not any recognized medical qualification under the provisions of the IMC Act, 1956, is not entitled to be registered on the State Medical Register: Indian Medical Register under the provisions of the said Act.
It is further stated that the Board of A & U System of Medicines is not the competent body to issue any certificate or authorize any person to practice in Modern Scientific System of Medicine.”
Also, vide order dated 25.11.2003 bearing No. R. 14015/25/96-U&H(R)(Pt.), the Ministry of Health and Family Welfare, Government of India has stated that:
“The matter regarding grant of recognition to the various streams of alternative medicine including electropathy / elctrohomoeopathy, has been under consideration of the Govt. in this process Govt. has considered the orders dated 18.11.98 of the Hon’ble High Court of Delhi in CWP No.4015/96 & OM No.8468/97 has inter-alia directed the Central/State Govts. to consider making legislation to grant of licenses to existing and new institutes etc. to control & regulate the various ‘unrecognized’ streams of alternative medicines and also give adequate publicity through media informing public about the ‘Respondents’ and similar other institutes being recognized by the Govt. & affiliated with any of the Councils.
Government constituted a ‘Standing Committee of Experts’ under the Chairmanship of Director General, Indian Council of Medical Research (ICMR) and members were drawn from various fields of medicine to consider and give its recommendations to the Government, on the efficacy/merits of various streams of alternative medicine and also examine feasibility of making legislation as suggested by the Hon’ble Court.
The Committee developed essential and desirable criteria for grant of recognition to a new stream of medicine and analysed the different streams of ‘Alternative medicine viz. Ayurveda, Siddha, Unani, Homeopathy, Yoga & Naturopathy, Electropathy/Electro Homoeopathy, Acupuncture, magnetotherapy, Reiki, Reflexology, Urine Therapy/Autourine Therapy, Hypnotherapy, Aroma Therapy, colour Therapy, Pranic Healing, Gems & Stone Therapy and music Therapy.
The Committee did not recommend recognition to any of these alternative medicines except the already recognized traditional systems of medicines, viz Ayurveda, Siddha, Unani, Homoeopathy and Yoga & Naturopathy which were found to fulfil the essential & desirable criteria developed by the Committee for recognition of a system of medicine. The Committee has, however, recommended that certain practices as Acupuncture and Hypnotherapy which qualified as modes of therapy could be allowed to be practised by registered practitioners or appropriately trained personnel. The Committee further suggested that all those systems of Medicine not recognized as separate Systems should not be allowed to continue full time Bachelor and Master’s degree courses and the term “Doctor” should be used only by practitioners of Systems of medicine recognized by the Government of India. Those considered as mode of therapy can be conducted as certificate courses for registered medical practitioners whether modern medicine of India Systems of Medicine and Homoeopathy.
After carefully examining the various recommendations of the Committee, the Government accepted these recommendations of the Committee. Accordingly, it is requested that the State/UT Govt. may give wide publicity to the decision of the Govt. They may also ensure that institutions under the State/UT do not grant any degree/diploma in the stream of medicine which has not been recommended for recognition and the term ‘Doctors” is used by practitioners of recognized systems of medicine.”
The above mentioned landmark judgement of Hon’ble Supreme Court titled as “Dr. Mukhtiar Chand versus The State of Punjab, 1998 (7) SCC 579,” has been duly followed by the Hon’ble High Court of Patna in the matter titled as “Sri Sarjoo Prasad and Others versus The State of Bihar, 2003 (51) BLJR 686” wherein the Hon’ble High Court of Patna has held that:
“9. From a bare perusal of Section 15(2)(b) it is apparent that unless a person is enrolled on State Medical Register as medical practitioner, he cannot practise medicine, nor he can sign or authenticate any medical certificate or any certificate required by any law to be signed or authenticated by a duly qualified medical' practitioner. Thus, notwithstanding that an Occupational therapist or Physiotherapist holds diploma/degree in Occupational therapy or Physiotherapy granted by the University on the basis of the course of studies prosecuted by him, if he is not enrolled on a State Medical Register, he cannot practise modern medicine. Indeed, medical qualification included in the Schedule of the Indian Medical Council Act only entitles the person to be enrolled on a State Medical Register, but without such enrolment even he cannot practise medicine. It is relevant to mention here that Sub-section (2) of Section 15 of the Indian Medical Council Act was added by Act 24 of 1964 with effect from 16-6-1964. Prior to the amendment there was no such provision that only a person enrolled on 'State Medical Register' can practise modern science medicine.”
Thus, the physiotherapist by claiming to be a medical consultant among the general public by prefixing the word “Dr” with their name and by running a pain and rehabilitation clinic without sufficient registration, are committing the offence of cheating the general public by faking certificate of an Association to be that of a statutory body. Also, the said persons have also committed an offence under section 336, 417, 418, 419, 425, 469 read with section 471 of Indian Penal Code. The act of the physiotherapists by running a pain and rehabilitation clinic and treating patients on their own without medical supervision and the required registration with the respective councils is dangerous to the life of the general public.
In view of the above discussions, it is opined that the physiotherapists are not allowed to portray themselves as registered medical practitioners by prefixing the word “Dr” with their name. If any physiotherapist prefixes the word “Dr” with his/her name, then he/she shall be treated as quack as mentioned by the Hon’ble Supreme Court and all laws as applicable on any quack shall be also applicable on said physiotherapists who is prefixing “Dr.” with the name and who is portraying as the medical practitioner/medical consultant.