Delhi High Court
Urvashi Popli vs Uoi & Ors. on 15 April, 2009
Author: Ajit Prakash Shah
* IN THE HIGH COURT OF DELHI AT NEW DELHI
11.
+ W.P.(C) 140/2007
URVASHI POPLI .....Petitioner
Through: Petitioner in person
versus
UOI & ORS. ..... Respondents
Through: Mr. Sewa Ram, Mr. R.K. Bachchan,
Advs. for Respondent No.1
Mr. Maninder Singh, Adv. with Mr. Kirtiman
Singh, Mr. T. Singhdev, Advocates for
Respondent No.2/MCI
Ms. Geeta Mehrotra, Adv. for R-6
Mr. V.K. Tondon, Adv. for Govt. of Gujarat
CORAM:
HON'BLE THE CHIEF JUSTICE
HON'BLE MR. JUSTICE NEERAJ KISHAN KAUL
ORDER
% 15.04.2009
The petitioner Smt. Urvashi Popli, a practicing lawyer, has filed
this petition in public interest seeking to challenge the instructions
issued by Union of India through Secretary, Ministry of Health and
Family Welfare vide D.O. No. M12015/22/2002-MCH dated 5.1.2006
and D.O. No. M.120115/22/ 2001-MCH dated 7.10.2005 for providing
in-house / on the job training in Anesthesia to government doctors to
be posted at First Referral Units (FRU) / Community Health Centres
(CHC) at sub-district level in order to control the alarming high
maternal deaths in the country. The petition appears to have been
filed at the behest of Indian Society of Anesthesiologists
(Respondent No.6 herein) who has been opposing Anesthesia
Training Programme on the misplaced apprehension that the
training to handle the emergency obstetric care at FRUs would be
taken as an additional medical qualification in Anesthesia which is
factually incorrect. The Government of India makes it very clear that
this training programme, formulated in the national interest, is
WP(C) No.140 of 2007 Pg.1
limited to the requirement of tackling emergency obstetric situations
only and neither can be construed as an additional qualification /
specialization nor entitles the person to practice anesthesiology
generally except to tackle the emergency obstetric situations at FRU
level while in Government service nor in any way replaces the
specialist anesthetists who are working after pursuing
degree/diploma in the subject.
The issue of high 'Maternal Mortality Rate (MMR)' in the
country has been a matter of grave concern to the Government of
India. As per World Health Organization Report, 2005, the MMR ratio
per one lakh births in India was 450 against only 44 in Thailand, 56
in China and 92 in Sri Lanka and less than 10 in the developed
countries. The non-availability of Emergency Obstetric Care (EmOC)
at the FRUs due to lack of qualified personnel is the primary cause of
high MMR. Sri Lanka, Thailand, Malaysia and Egypt are few
examples which have drastically reduced the MMR below 100 by
training in midwifery and variety of integrated skills. The 10 th Five
Year Plan recommended for a six month training course on
Anesthesia for serving government doctors. The Government of
India, in association with WHO, UNICEF, UNFA, DFID, AIIMS and the
States, identified 21 States and 91 medical colleges to organize
programmes to train Government MBBS doctors on Life Saving
Anesthetic Skills (LSAS) for emergency obstetric care.
The training programme has begun in 2006 and it is reported
that as on 31.12.2008, 611 doctors have been trained across 93
colleges in 24 States while 209 Master trainers are trained. A similar
training programme in Emergency Gynecological Care for
government doctors has been undertaken in association and active
participation of the Gynecologists Association of India. The Medical
WP(C) No.140 of 2007 Pg.2
Council of India has consented to the Life Saving Anesthetic Skills
Training for Emergency Obstetric Care and has suggested for its
review at the end of five years to judge the efficacy of the
programme and the desirability of its continuing after taking into
account the availability of qualified obstetricians and
anesthesiologists at the FRU level.
In the rejoinder that has been filed by the Respondent No.6
Society, it is alleged that the doctors who have completed four and a
half months training have not been posted in FRU and are posted to
the City/District hospitals to work as full-fledged anesthetists and
some others, posted back to their earlier designations, are doing
general medical duties, postmortem work, emergency cover duties
etc. It is further alleged that most of the FRUs/CHCs are yet to be
equipped with anesthesia machines, monitors and blood storage
units. Further, in paragraph 5 of the rejoinder, it is suggested that
the period of training should be increased to minimum of 12 months
in the medical college departments and certain other suggestions
are also made.
In the additional affidavit filed by the Government of India, it
has been demonstrated that the allegations of non posting of trained
doctors are not correct. Almost all the doctors have been posted at
FRUs after giving them training at the district centres.
It is also seen from the affidavit that the Government of India
intends to operationalise approximately 4000 FRUs with the trained
doctors, of which 1652 have been made operational. That for
remaining 2348 FRUs, the issues relating to availability of blood
storage centre, trained/qualified doctors and the infrastructure are
being handled vigorously in association with the State Governments
which include the subject training programme. The Government of
WP(C) No.140 of 2007 Pg.3
India intends to train a total of about 5000 doctors to meet the
requirement of LSAS at FRUs considering the non-availability of
some trained doctors due to their career pursuits, promotions etc. It
is also seen that the doctors who undergo the training in LSAS are
retained at district hospitals for a few months to gain practical
experience to handle the obstetric emergency situations under the
qualified specialists before being posted to the FRUs.
As far as the suggestion for increasing the period of training, it
is seen that it will defeat the very basic purpose of the Scheme. As
far as the other suggestions are concerned, respondent No.6 society
is free to forward them to the MCI for consideration. MCI may
consider those suggestions while considering the issue of
continuation of the scheme.
With the above observations, the writ petition stands disposed
of.
CHIEF JUSTICE
NEERAJ KISHAN KAUL, J
APRIL 15, 2009
pk
WP(C) No.140 of 2007 Pg.4
