Full Judgment Text & Judicial Ruling

P L D 2026 Lahore 122 Before Raheel Kamran, J SHAUKAT KHANUM MEMORIAL TRUST and another ---Petitioners Versus The PROVINCE OF PUNJAB through Chief Secretary and others ---Respondents Writ Petition No. 82278 of 2023 (and other connected Petitions), decided on 29th October, 2025. (a) Punjab Healthcare Commission Act (XVI of 2010)--- ----Ss.2(xvi), 2(xv) & 40(2)(m)---Punjab Healthcare Commission (Pricing of Healthcare Services) Regulations, 2023, Cl.4 Ch.-I ---Price control---Services rendered by healthcare establishments---Regulating and controlling prices of healthcare services provided by hospitals and diagnostic centers---Authority and jurisdictional reach of Punjab Healthcare Commission---Determination---Regulation of prices of services not being applicable to labs and diagnostic centers, plea of---Legality---Brief facts of the matter were that multiple writ petitions were filed by hospitals and diagnostic centres challenging the Punjab Healthcare Commission (Pricing of Healthcare Services) Regulations, 2023 ( Regulations )---The petitioners were healthcare establishments operating within Punjab and some were also functioning trans-provincially---The Regulations under question required all healthcare establishments to undertake activity-based costing through certified firms, cap profit margins at 20%, and submit prices to the Punjab Healthcare Commission ( PHC ) for approval---PHC framed these Regulations under S. 40(2)(m) of the Punjab Healthcare Commission Act, 2010 ( Act )---The pivotal issue for determination before the High Court was whether PHC had lawful authority under the Act to regulate and control prices of healthcare services, including those offered by diagnostic centres, and whether the Regulations were validly promulgated in accordance with statutory requirements? ---Held: Services provided for diagnosis clearly fell within the definition of healthcare services---In S. 2(xv) of the Act, 2010, theterm healthcare establishment had been defined, which explicitly included diagnostic centres---Regulation of diagnostic labs, including aspects related to their services and pricing, fell squarely within the broad objectives of improving the quality of healthcare services and addressing ancillary matters as envisioned by the Preamble of the Act---Section 40 of the Act directly addressed the power to make regulations for control of prices of healthcare services---Clause (4) of Chapter I of the impugned regulations stated that the Regulations apply, inter alia, to healthcare establishments, including but not limited to public or private hospitals and diagnostic centres---In view of the unequivocal and unambiguous language used by the legislature, Act, 2010, clearly conferred upon PHC the authority to regulate and control the prices of healthcare services, including those provided by diagnostic labs---Regulating prices for essential healthcare services directly served the constitutional mandate by prevent ingarbitrary overcharging and ensuring equitable access---Services offered by diagnostic centers, such as lab tests, were integral to healthcare delivery, and allowing varied pricing for identical services based solely on the facility type would undermine the very purpose of regulation, that was, to protect the consumer from exploitation---Question of treating dissimilarly placed entities similarly did not arise, and any such plea of discrimination was manifestly unfounded---Pricing mechanism laid down therein was not an arbitrary exercise of power by the PHC---Instead, the Regulations required healthcare establishments to perform their own activity-based costing, thereby entrusting them with the primary role of determining their service prices---Intervention of PHC was limited to setting a maximum profit margin of 20%, which served as a fair and rational cap to ensure that prices remained accessible without undermining the concerned healthcare establishments financial viability---Petitioners (healthcare establishments) could not assert and provide any substantial material to demonstrate that capping the profit margin at 20% was unreasonable or represented an irrational return on investment in the provision of healthcare services---PHC was duly empowered to regulate and control the pricing of healthcare services rendered by healthcare establishments including diagnostic facilities and laboratories throughout the province---The objections raised to the validity of the Punjab Healthcare Commission (Pricing of Healthcare Services) Regulations, 2023, were thus found to be untenable---All writ petitions were dismissed, in circumstances. Ghulam Rasool v. Muhammad Hayat PLD 1984 SC 385; Muhammad Mubeen-us-Salam and others v. Federation of Pakistan through Secretary, Ministry of Defence and others PLD 2006 SC 602 and Pepper (Inspector of Taxes) v. Hart 1993 SCMR 1019 rel. (b) Punjab Healthcare Commission Act (XVI of 2010)--- ----Preamble---Legislative intent---Scope---A careful reading of the Preamble reveals that the legislative intent behind the Act, 2010 is multi-faceted i.e. (i) to make provisions for the improvement of quality of healthcare services, (ii) to ban quackery in all its forms and manifestations and (iii) to provide for ancillary matters---One of the purposes of the Act, 2010 according to its preamble is to make provisions for the improvement of quality of healthcare services---The phrase ancillary matters as used in the Preamble of the Act, 2010,signifies that the Act, 2010 is designed to address all incidental or supplementary issues necessary to achieve its primary goals---While the preamble of the Act, 2010 may provide guidelines, the core of the Punjab Healthcare Commission s powers must be found in the substantive provisions of the Act, 2010. (c) Constitution of Pakistan--- ----Arts.141 & 142---Punjab Healthcare Commission Act (XVI of 2010), S. 40---Punjab Healthcare Commission (Pricing of Healthcare Services) Regulations, 2023, Cl.4 Ch.-I ---Regulating and controlling prices of healthcare services provided by hospitals and diagnostic centers---Trans-provincial status of healthcare establishments---Effect---Regulatory reach of the province and its jurisdiction over activities performed within territorial limits---Scope---Legal position in Pakistan, as gleaned from Constitutional provisions (Arts. 141 and 142) and consistent case law, is that while a Provincial government cannot unilaterally regulate the entire affairs of a trans-provincial entity, it is authorized to establish regulations applicable within its territorial jurisdiction---Healthcare is primarily a Provincial subject---Therefore, where healthcare services are provided within the Province, the Provincial Government and its authorized Commission (PHC) retain the legislative and regulatory competence over those activities---The argument that regulating a trans-provincial entity within its provincial operations would render its operations in other provinces uncompetitive or unfeasible is a policy consideration, not a legal bar to the Province s authority to regulate activities occurring within its territorial limits. Punjab Healthcare Commission v. Mushtaq Ahmed Chaudhary and others PLD 2018 Lahore 762 ref. (d) Interpretation of statutes--- ---- Preamble of a statute, reliance upon---Scope---If an enactment and its provisions are well defined and unequivocal, Preamble cannot be relied upon solely to override express provisions of law without considering its pith and substance. Ghulam Mustafa Insari and 48 others v. Government of the Punjab and others 2004 SCMR 1903 and Sui Northern Gas Pipelines Ltd. (SNGPL), Islamabad v. Messrs S.K. Pvt. Limited and others 2025 SCMR 570 rel. Raza Imtiaz Siddiqui, Barrister Asad Rahim Khan, Ms. Nimra Arshad, Faiz-e-Azhar, M. Usman Ghani, Syed Zeeshan Haider Zaidi, Mian Muhammad Arshad Iqbal, Uzair Sajid, Allah Nawaz Sial, Hafiz Rahman Aziz, Muhammad Abdullah Arif, Barrister Asim Malik, Muhammad Naeem Beryar and Bukhtiar Hyder Khan (in the connected writ petitions). Barrister Ch. Muhammad Umar, Mufti Ahtsham Ud Din Haider and Abdul Rehman for Respondents Nos. 3 and 4-PHC. Muhammad Osman Khan, Assistant Advocate General with Naveed Ahmad Goraya, Law Officer, Specialized Healthcare and Medical Education Department. Muhammad Azhar Siddique along with Salma Riaz and Amna Liaqat for the Applicant (in C.M. No.1 of 2024 in W.P. No. 65058 of 2023). Date of hearing: 23rd September, 2025. JUDGMENT RAHEEL KAMRAN, J.---This judgment shall decide the titled Writ Petition as well as Writ Petitions Nos.65058 of 2023, 84729 of 2023, 17901 of 2024, 17907 of 2024, 17908 of 2024, 17895 of 2024, 17910 of 2024, 17914 of 2024 and 26011 of 2024 for all these cases primarily challenge the Punjab Healthcare Commission (Pricing of Healthcare Services) Regulations, 2023 (hereinafter to be referred as impugned Regulations ) on the grounds of being ultra vires, the Constitution of the Islamic Republic of Pakistan, 1973 ( hereinafter, the Constitution ), Punjab Healthcare Commission Act, 2010 (hereinafter, the Act, 2010 ) along with subsequent proceeding, e.g., letters dated 12.07.2023 and 27.07.2023, notification dated 11.09.2023 and 27.09.2023 as well as framework formulated on 27.09.2023. 2. Specifically, Shaukat Khanum Memorial Trust, the petitioner in the titled petition, is a charitable and trans-provincial organization operating hospitals and diagnostic centers across Pakistan. Similarly, most petitioners in the connected cases are also engaged in providing trans-provincial diagnostic services, including blood evaluations, X-rays, Ultrasounds, Magnetic Resonance Imaging (MRI) and biopsies, among others. 3. It is contended by Mr. Raza Imtiaz Siddiqui, Advocate learned counsel for the petitioner in the titled petition that the impugned regulations are beyond the confines of the Act, 2010 for the commission is possessed with no lawful authority whatsoever to fix prices of the services provided by the healthcare institutions, including the ceiling price. He adds that the regulatory regime contemplated under section 40 of the Act, 2010 at the most, can ask the petitioners to provide and display a price list and investigate any complaint for charging over and above the said price for the services provided by the healthcare institutions. It is emphasized by the learned counsel that under no circumstances, prices for the services provided by healthcare institutions can be fixed under the garb of regulations. He further submits that in terms of section 4(4) read with section 10 of the Act, 2010, a Technical Advisory Committee is required to be constituted under the Act, 2010 in consultation with the Commission to address, inter alia, policy matters including price regulation or unlawful fixation thereof. Adds that as the Technical Advisory Committee has not been constituted till date, the Commission is acting coram non judice. Learned counsel maintains that the petitioner is a trans-provincial entity extending its operations also to the other provinces, therefore, the Province of Punjab has no jurisdiction to regulate the affairs of such trans-provincial entity and that the impugned regulation may render operations of the petitioner in other provinces uncompetitive and not financially feasible. 4. Mr. Muhammad Usman Ghani, Advocate for the petitioner in Writ Petition No.65058 of 2023 contends that the application of the impugned regulations to the petitioner s Lab and Diagnostic Center is unwarranted due to a complete lack of evidence with the Commission qua overcharging by the petitioner. He adds that the imposition of such pricing controls, absent any demonstrated necessity, constitutes a disproportionate measure that fails both the test of necessity and minimum impairment. He maintains that these regulations are discriminatory, as they unfairly equate a non-hospital entity like the petitioner s with private hospitals. To elaborate on the difference in classification, the learned counsel points to the Punjab Healthcare Commission Licensing Regulations, 2020, specifically regulations 2(1)(d) and 2(1)(r), highlighting the Commission s recognition of 21 distinct types of healthcare facilities. He further submits that the Supreme Court s directives were specifically concerning hospitals and do not extend to diagnostic centers. The learned counsel argues that the Commission's broad and generalized classification approach is unreasonable in the Wednesbury sense. He strenuously argues that the impugned regulations are ultra vires the Act, 2010, primarily due to the Commission s failure to comply with two mandatory statutory requirements: neglecting to properly consider the policy advice of the Technical Advisory Committee under Section 4(4)(a) and critically, failing to publish the draft regulations for public opinion in the official gazette and widely circulated newspapers as mandated by Section 40(3) of the Act, 2010. He concludes by submitting that Section 40 of the Act, 2010 also lacks specific legislative guidelines to structure the Commission s discretion in framing such regulations. 5. In addition to the arguments already presented by learned counsel for the petitioners in other petitions, Barrister Asad Rahim Khan, Advocate, learned counsel for the petitioners in Writ Petitions Nos. 17895, 17908, 17907, 17910, 17901 and 17914 of 2024 contends that section 40(2)(m) of the Act stands without the support of any independent provision within the Act, 2010 that specifically empowers the Commission or prescribes its functions concerning the regulation and mechanism for the fixation of prices. Learned counsel emphasizes this deficiency by drawing a contrast with other regulatory statutes, such as the Drug Regulatory Authority of Pakistan Act, 2012, the Regulation of Generation, Transmission and Distribution of Electric Power Act, 1997, and the Oil and Gas Regulatory Authority Ordinance, 2002, wherein powers for price regulation are clearly delineated in specific sections like section 7 in the former two and sections 6(2)(r) and 6(2)(s) in the latter. Learned counsel further argues that the underlying purpose and object of the Act, 2010, according to its preamble, were centered on regulating the quality and standards of healthcare services and effectively controlling quackery within the Province of Punjab. Learned counsel emphasizes that the Act, 2010 was not intended to serve as a tool for regulating or fixing the prices of healthcare services. This assertion, according to learned counsel, is manifest from the parliamentary debates at the time of the bill s proposal and enactment, where no mention was made of price regulation as a legislative objective. To properly discern the statute s true purpose and object, learned counsel advocates for the consideration of Hansard, citing the pronouncement of the UK House of Lords on the principles of statutory interpretation in the case of Pepper v. Hart (UKHL) (1993 SCMR 1019).

6. Notice under Order XXVIIA of the Code of Civil Procedure, 1908 (CPC) was issued to the Advocate General, Punjab, who filed report and parawise comments. Mr. Mohammad Osman Khan, the learned Assistant Advocate General, Punjab, in his arguments while affirming the report and parawise comments controverts the stance of the learned counsel for the petitioners. He further contends that the vires of section 40(2)(m) of the Act, 2010, which confers upon the commission the authority to regulate prices of healthcare services, have not been assailed in any of the petitions. He maintains that the impugned regulations have been issued in accordance with the mandate of the said section and are not ultra vires any provision of the Constitution or the law. 7. Barrister Ch. Muhammad Umer, Advocate for the Punjab Healthcare Commission in W.P. No.65058 of 2023, while making reference to the case of Punjab Healthcare Commission v. Mushtaq Ahmed Chaudhary and others (PLD 2018 Lahore 762) contends that matters concerning health, healthcare services, and hospitals are not included in the federal legislative list, thus falling under the exclusive jurisdiction of the Province, a judgment which upheld the constitutional validity of the Punjab Healthcare Commission Act, 2010. While referring to the preamble of the Act, 2010, it is emphasized that the Commission has been constituted, inter alia, for improvement of quality of healthcare services and the provision for ancillary matters. Reference has also been made to section 4(1) of the Act, 2010 to emphasize that performance of functions is required to improve the quality of healthcare services and clinical governance. Section 40(2)(m) is referred to contend that there is an express power to formulate regulations regarding control of prices and monitoring of healthcare services. It is further contended that regulating the quality of healthcare services inherently necessitates regulating their pricing. The ability to control quality is considered inseparable from the ability to control the cost of accessing such services. To further illustrate this point, learned counsel has referred to section 14(2A) of the United Kingdom s Sale of Goods Act of 1979. This reference is aimed at highlighting that, under that Act, Parliament stipulated that the determination of quality should consider, among other relevant factors, the price and description of the goods. Learned counsel further relies on the Consumer Rights Act, 2015, section 9(2) whereof embodies similar considerations, including price, for the purpose of regulating quality. It is emphasized that these examples clearly demonstrate the nexus between price regulation under section 40 of the Act, 2010 and the regulation of quality and standards as outlined in section 4(1) as also the preamble of the Act, 2010. Learned counsel for the Commission emphatically argues that the regulation of price for healthcare services is not unique to Punjab, as similar provisions exist in the regulatory regimes introduced by other provinces. Reference in this regard has been made to the preamble and sections 4(1), 4(2)(c), 4(2)(m) and 4(2)(o) of Sindh Healthcare Commission Act, 2013; preamble and section 6(1) alongwith section 31 of The Khyber Pakhtunkhwa Healthcare Commission Act, 2015; preamble along with sections 4(1)(f), 4(1)(l), 4(1)(v) and 4(1)(p) of Islamabad Healthcare Regulation Act, 2018 and preamble and sections 4(1), 4(2)(b), and 4(2)(g) of Balochistan Healthcare Commission Act, 2019. He next submits that the Commission substantially complied with Section 40(3) of the Act, 2010, by publishing the draft price regulations in the official gazette, advertising for objections in major newspapers, and making the full draft available on its website, arguing that the petitioners contention regarding full newspaper publication is misconceived given the absence of such a statutory requirement and the impractical burden it would impose. Emphasis is placed on the fact that it is not case of any of the petitioners that objections were raised by them which were not dealt with or taken into consideration by the Commission before finalizing the draft regulations. Learned counsel clarifies that it was only after promulgation of the regulations that objections were raised by some of the petitioners to the regulations and these objections were addressed to the extent legally permissible. Moving to the next submission, the learned counsel asserts that the Commission, as a corporate body, is to operate under general superintendence, direction and management by the Board constituted under section 5(1) of the Act. He argues that the Technical Advisory Committee (TAC) is subordinate and only provides advice when specifically requested by the Commission. The learned counsel emphasizes that if TAC consultation were mandatory for regulation promulgation, it would have been explicitly stated in the Act, 2010. Responding to the claim that the impugned regulations lacked specific direction of the Supreme Court for diagnostic labs pricing, the learned counsel argued that Section 40(2)(m) of the Act, 2010 broadly empowers the Commission to regulate and control prices across all healthcare establishments, including diagnostic centers. It is added that the categorization under the licensing regulations is solely for licensing purposes and does not apply to price regulations. Therefore, the question of treating dissimilarly placed entities similarly does not arise, and any plea of discrimination is unfounded. Learned counsel for the Commission further contends that recourse to Hansards is unnecessary when statutory provisions are clear in their meaning and scope, as Hansards cannot aid interpretation in such cases. In response to the plea of the petitioners qua trans-provincial status of some of the petitioners, it is contended that since the healthcare services in question are provided within the province of Punjab, regulating these activities falls squarely within the jurisdiction of the province of Punjab. 8. During the pendency of this matter, C.M. No.1 of 2024 was filed in Writ Petition No.65058 of 2023 by Judicial Activism Panel, human rights and public interest litigation association, which seeks to implead the applicant as party to this matter. Mr. Muhammad Azhar Siddique, Advocate for the applicant contended that the Act, 2010 has genesis in the order dated 30.12.2009 passed by the Supreme Court in C.P. No.2510-L/2009. He also pointed to several orders passed by the Supreme Court in the years 2018 and 2019 and order from W.P. No. 75490 of 2022, none of which was assailed or reversed. He stressed that healthcare is a necessary service that is controlled everywhere so Pakistan is not an exception in regulating its prices. He added that the impugned regulation fits with the government s duty under Article 3 of the Constitution to stop people from being taken advantage of. 9. Arguments heard and record perused. 10. All the petitions to be decided by way of this consolidated judgment primarily challenge the impugned regulations. It would not be out of context to mention here that none of the petitioners have assailed the vires of Section 40(2)(m) itself, thus accepting that price regulation is within the permissible scope of the Act, 2010. As the impugned regulations derive their legal force from the Act, 2010, the threshold question is to determine the legitimate scope and jurisdictional reach of the Act, 2010, particularly concerning its authority to regulate and control prices of healthcare services provided by healthcare establishments within the Province of Punjab. 11. Thrust of the arguments of the learned counsel for the petitioners in the connected petitions is on the point that regulation of prices of services provided by labs and Diagnostic Centres does not fall within the purposes embodied in the preamble of the Act, 2010. For better appreciation of its context, the preamble to the Act, 2010 is reproduced below.

Preamble:- Whereas it is expedient to provide for establishment of the Punjab Healthcare Commission, to make provisions for the improvement of quality of healthcare services, to ban quackery in all its forms and manifestations and to provide for ancillary matters. A careful reading of the preamble reveals that the legislative intent behind the Act is multi-faceted i.e. (i) to make provisions for the improvement of quality of healthcare services, (ii) to ban quackery in all its forms and manifestations and (iii) to provide for ancillary matters. The term healthcare services has been defined in section 2(xvi) of the Act, 2010 as under: - healthcare services means services provided for diagnosis, treatment or care of persons suffering from any physical or mental disease, injury or disability including procedures that are similar to forms of medical, dental or surgical care but are not provided in connection with a medical condition and includes any other service notified by the Government; The services provided for diagnosis clearly fall within the above definition of healthcare services. In Section 2(xv) of the Act, 2010, the term healthcare establishment has been defined, which explicitly includes diagnostic centres. For ready reference, section 2(xv) is reproduced here-under: - healthcare establishment means a hospital, diagnostic centre, medical clinics, nursing home, maternity home, dental clinic, homeopathy clinic, Tibb clinic, acupuncture, physiotherapy clinic or any other premises or conveyance One of the purposes of the Act, 2010 according to its preamble is to make provisions for the improvement of quality of healthcare services. The phrase ancillary matters as used in the preamble of the Act, 2010, signifies that the Act is designed to address all incidental or supplementary issues necessary to achieve its primary goals. 12. Healthcare services cannot be regarded as mere commercial commodities. They constitute an essential and integral facet of the right to…

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