Davinder Bhasin vs Union Of India &Another
2012 Latest Caselaw 4142 Del

*        IN THE HIGH COURT OF DELHI AT NEW DELHI

+                       W.P.(C) 3972 OF 2011


                                     Judgment reserved on:16.5.2012
                                     Judgment pronounced on: 13.7.2012

DAVINDER BHASIN                                     ..... PETITIONER
                          Through:     Mr. Aditya Singh, Advocate.

                                   Versus

UNION OF INDIA &ANOTHER                           ..... RESPONDENTS

                  Through:             Mr Neeraj Chaudhari, CGSC with
                                       Mr. Ravjyot Singh, Advocate for
                                       UOI.
                                       Ms Purnima Maheshwari, Advocate
                                       for R.2
                                       Mr. Sajad Sultan with Mr. Amritesh
                                       Mishra, Advocate for R.3

          CORAM:
          HON'BLE THE ACTING CHIEF JUSTICE
          HON'BLE MR. JUSTICE RAJIV SAHAI ENDLAW


A.K.SIKRI, ACTING CHIEF JUSTICE:

1. In this writ petition, which is in the nature of Public Interest

Litigation (PIL), the petitioner seeks direction to the respondents for

compulsory basic life support training to be given to all the personnel

working in all the Hospitals in India and also to personnel of military, para

military, fire

fighting agencies, police etc. According to the petitioner the bitter

experience he had, while is mother Mrs. Raj Kaushlaya Bhasin was getting

treatment has come to fore, the necessity of such a training to each and

every employee working in the hospitals. He has mentioned in the writ

petition as to how the lack of training with hospital attendant who are

deputed to take care of his mother led to her unfortunate death. The

narration given by the petitioner in this behalf, in the writ petition is as

under:-

The petitioner‟s mother aged 86 years, was admitted to Max Hospital,

1 Press Enclave Road, Saket, New Delhi for the treatment of pneumonia.

She was put under the supervision of Dr. Mishra and Dr. Sanjeev Budhiraja.

The doctors advised various tests for petitioner‟s mother which were

conducted on 8.1.2011 and 9.1.2011. The patient was kept under the

supervision and care of the hospital and was not discharged. While in

hospital, on 9.1.2011, the oxygen saturation rate of the petitioner‟s mother

had dropped and she was put on oxygen support after which her oxygen

saturation rate improved to 95%.. On 9.1.2011 while the patient was in a

private room in the ward, in the evening, she wanted to pass urine and called

for a hospital attendant for assisting her. The hospital attendant deputed at

the ward came to her assistance but instead of giving her a bed pan (which is

given to patients in serious health conditions) she decided to take her to the

washroom without looking at the treatment chart of the patient. The

attendant took off the oxygen mask of the patient and moved her to

washroom on a wheel chair. Because of removal of the oxygen mask, the

oxygen saturation level of the patient dropped drastically leading to hypoxia

(low oxygen) and arrhythymia arrest. When the patient could not move to

get out of the wheelchair, the attendant instead of calling the doctors started

calling the family members of the patient. On realizing the gravity of the

situation the family members of the patient raised an alarm to call for other

attendants and doctors but valuable time had been lost by them and this

proved to be fatal for the patient. The petitioner‟s mother passed away due

to the negligence of an ill-trained medical attendant.

2. For this reason, the petitioner has drawn the attention of this Court

towards the fact that the fate of critically ill patients lie in the hands of the

staff members and medical attendants in hospital and personnel who are the

"first responders" in critical situations and in the absence of such training,

they are incapable of handling huge responsibility. He has thus submitted

that basic life support training should not only be confined to staff nurses

etc. but be given to each and every staff in the hospital so that valuable

human life is not lost due to their negligence. The petitioner also provides

another justification for this kind of training stating that it would increase

the number of trained personnel in the society at large without even putting

any substantial burden over the infrastructure both financial or otherwise.

This could ensure availability of skilled and semi skilled hands which could

prove to be handy in cases of natural calamities ensuring that atleast

immediate first aid is given to the patient while also ensuring that the correct

message reaches the correct doctor at the shortest possible time so that time

is not wasted in starting the treatment of the person needing immediate

medical attention. The petitioner also mentioned that in the study

conducted by Association of physicians in India entitled as „White Paper on

Academic Emergency Medicine in India: Indo-US joint working Group

(JWG) published in JAPI. Vol. 56 October, 2008, it is noted that at present

in India there is no dedicated emergency medical faculty accredited by the

Medical Council of India. It also mentions that there are no dedicated

trauma surgeons in India and also that there are a very few dedicated trauma

centres in India, but unlike India, in United States of America, Accredited

Council for Graduate Medical Education (ACGME) and the Residency

Review Committee (RRC) for emergency medicine govern training thereof

which is predominantly three years in length and are designed to prepare

physicians for every practice of emergency medicine. Further physicians

are trained under qualified faculty to develop clinical maturity, judgment,

technical skills and a knowledge base in fundamentals of Emergency

Medicine, however, in a country like India which is a country of over a

billion people and a hub of medical tourism, is found to be lacking. The

petitioner has also referred to Article 47 of the Constitution of India which

declares that it shall be the duty of the State to raise the level of care and

improve the standard of public health requirements in the Hospital, which

would reach a higher level if all employees of hospital are trained at least in

giving basic first aid treatment to a patient in urgent need of medical help.

He has also invoked the provisions of Article 21 of the Constitution which

protects the Right to Life, which is fundamental right of every citizen and

includes right to health and medical care. The petitioner has further

mentioned that at present there is no Central law in India. Only the

legislature of Gujarat in 2007 passed the Gujarat Emergency Medical

Services Act, 2007 (hereinafter referred to as the „Gujarat Act‟) to provide

for regulation of emergency medical services. The preamble of the

Gujarat Act reads as under:-

"An act to provide for emergency medical services in the state and for that purpose to establish Gujarat Medical Emergency Services Authority and City and District Emergency Services Councils in the state and for the matters connected therewith and incidental thereto."

3. Section 2 sub-Section 16 of the Gujarat Act defines a medical

emergency which reads as under:-

"2(16). "Medical Emergency" means a situation-

(a) Where an individual needs such immediate medical attention and the absence of which would place his health in serious jeopardy, or

(b) Where the potential for such need is perceived by emergency staff."

4. Section 14 of the Gujarat Act lays down the standards of training of

the Emergency Medical Technicians. Further, it also ensures training

programmes for Emergency Medical Services Technicians who are defined

under Section 2 (13) of the Act is an individual who is trained in all aspects

of the basic life supports according to the standard prescribed by the

authority and further who holds a valid certificate issued by the authority.

5. In the counter affidavit filed on behalf of the Union of India it is

stated that basic health support training is required for only those hospital

employees who are involved in "direct patient care" and not all the

employees of the hospital. As per the averments made in the counter

affidavits, efforts have been made by the Central Government Hospitals for

training on Basic Life Support for the Doctors, nurses and some

paramedical staff and this is based on a curriculum developed individually

by the individual hospitals. Other established organizations like Indian Red

Cross Society (IRCS) and GVK Emergency Management and Research

Institute (GVK EMRI, a pioneer in Emergency Management Services in

India running as a non-profit-making professional organization operating in

the Public Private Partnership (PPP mode) run Basic Life Support courses

on payment basis. It is stated that there is a centrally sponsored Trauma

Care Programme in which indentified district/state hospitals/Medical

colleges in the country are being provided assistance to augment their

capacity, both infrastructure and man powers, for handling trauma cases

and 140 such centres are identified in the 11th five year plan and 160 more

are proposed in the next five year plan. However, in the 9 th & 10th five year

plan 103 District hospitals on National highways were upgraded with

Emergency care facilities to treat the victims of Road Traffic Injuries and

other emergencies. According to the respondent, endeavour of providing

training to more number of persons in the society would require

augmentation of infrastructure and finance in consultation with other

departments of the Central Government like Ministry of Home Affairs,

Ministry of Defence and other departments. The respondent states that

Establishment of the Emergency Medical Services Authority at the national

level and similar subsidiary authorities at the State and District level

requires inputs from other Departments like Ministry of Home Affairs,

Ministry of Defence etc. considering the following points:

 Whether such training already exists for the above mentioned

personnel in the various departments.

 The expected annual workload for such a body, if established.

 Under which ministry, this body/authority will be established?

It is beyond the mandate of the Ministry of Health to decide on an

authority which will have an overall say over the basic life support training

needs for the military, para-military, fire services etc. The State

Governments and the concerned organisations of the military, para military

may define their training needs, develop the standardized training

programme and conduct the same to cater to their needs for capacity

building in terms of First Aid & Basic Life Support. The State

Governments, Military and para-military Organisations may utilize their

existing training curriculum or develop their own referring to the

curriculums of the Central Government Hospitals or that of the Indian Red

Cross Society, GVK EMRI or other similar organizations. They may like to

utilize the services of the organizations already doing this job as

enumerated.

6. The Government of NCT of Delhi which has been arrayed as

respondent no.2 has filed its own counter affidavit wherein it is mentioned

that a meeting was held on 5.9.2011 to discuss the issues of providing basic

life support training to all the staff working in the hospitals. The same was

held under the Chairmanship of Special Secretary (Health), Department of

Health & Family Welfare and was attended by the Medical Superintendents

of DDU Hospital, GB Pant Hospital and the Additional Medical

Superintendent of the Lok Nayak Hospital. These hospitals represent three

major hospitals under the GNCT of Delhi. It was informed to the Special

Secretary that most hospitals under GNCT of Delhi are already providing

training to the para medical staff. Further, time to time, training is also

being provided for the officials of centralized Accident and Trauma

Services (CATS) and even to the personnel of Delhi police.

The meeting recommended formation of a committee to review the

overall training programmes and to make it a regular/periodic feature.

Hence a Committee was formed under the Chairmanship of Dean, Maulana

Azad Medical College to find out the modalities and the standard operating

procedure for training to para-medical and Group D employees working

under the hospitals of NCT Delhi. A report of the said Committee is, as on

date, awaited. However, Dean, MAMC has submitted vide his letter dated

7.11.2011 that "life support training centre has been established in MAMC,

since 2005,and it has been providing training to medical personnel of all

cadres including paramedics, nurses, group D employees and doctors from

time to time. It has also created satellite training centres at DDU Hospital

and Bhagwan Mahavir Hospital in Delhi where similar training is being

imparted. The centre was also instrumental in the training of the healthcare

personnel involved in Commonwealth Games, 2010. Till date, it has trained

nearly 3000 personnel and continues to do so. However, there is no

organized system of training and teaching life support except for the under

and postgraduates admitted in MAMC for whom such training has been

made compulsory for the past four years. MS, Deen Dayal Upadhyaya

Hospital has also informed that their Hospital has given basic life support

(BLS) training to about 100 doctors and 300 nurses/technicians/group C

staff. Subsequently, a meeting was held under the Chairmanship of

Principal Secretary (Health & Family Welfare) on 21.11.2011 which was

attended to by MS, GB Pant Hospital, Addl.MS, Lok Nayak Hospital and

Special Secretaries of Department of Health & Family Welfare, GNCT of

Delhi wherein the contents of the writ petition and the requirement of basic

life support training to the personnel in the GNCT of Delhi hospitals was

further discussed. This issue was again taken up in the meeting of all the

Medical Superintendents of GNCTD hospitals on 28.11.2011. Further,

stand of the Delhi Government that though there is a need for Continuing

Medical Education (CME) and for providing refresher training courses

insofar as nurses, Doctors and para medical staff is concerned and

instructions are being issued to the Medical Superintendents to undertake

the same. Insofar as other hospital staff such as security, sanitation,

clerical, other Group C & D and various categories of paramedical staff, not

directly involved or responsible for providing life support services within

the hospital premises is concerned, do not require to be given training in

basic life support services. What is emphasized is that instead of giving

such a training, they need to be made aware of the standard operating

procedures and protocols pertaining to the care of the patients. In case of

any emergency, the said personnel are to alert the nurses and doctors on

duty so that life support can be provided by the concerned responsible

officers. However, even for the category of hospital personnel not directly

responsible for providing life support services refresher courses and

training programmes on need basis can be organized. Justification for this

approach is that in a hospital the over all care of the patients including

medical management and patient care is primarily under the supervision of

Doctor/Nurses. The nurses are supposed to follow the directions of the

doctor and as per need provide urgent emergency care as required. Nursing

orderlies are not directly responsible for providing life support services to

the patients. However, training of First-Aid is mandatory requirement for

any personnel to be selected as nursing orderly. Nevertheless, Govt. of

NCT of Delhi can impart training to nursing orderlies working in sensitive

areas like ICU/Operation theaters and in casualties/emergency areas.

Insofar as other facilities provided by the Delhi Government is concerned,

the averments in the affidavit go on to state that in Delhi the Centralized

Accident Trauma Services (CATS) was set up on the year 1989 with the

following aims and objectives:

i. Reaching the site of accident as quickly as possible.

ii. To give first aid and emergency management at the site

iii. Quick and safe transportation of the patient to the hospital

iv. To give knowledge of first aid to public through awareness

programmes, demonstrations and one day emergency first aid

course

v. To involve, liaise with other organization such as Delhi Police,

Delhi Fire Service, Disaster Management or any other

government agencies of the benefit and the cadre of the

accident victims.

CATS have on date employed 42 ambulances and 219 personnel.

The Govt. is in the process of acquiring another 70 ambulances which will

be operational under a suitable model. These ambulances are supplemented

by a number of ambulances available with Govt. other non government

hospitals. Patient transport in a pre-hospital emergency like road accident is

also done by PCR Van. Each CATS ambulance is manned by two Asstt.

Ambulance Officers who are Graduate trained in multi disciplinary skills of

first aid and emergency management. Refresher course trainings are

conducted for the Assistant Ambulance Officers from time to time . There

is, therefore, an existing set up of organized response to pre-hospital

emergency and the Govt. is also in the process of further enhancing and

improving the said infrastructure.

7. The Max Hospital where the mother of the petitioner was admitted is

also arrayed as respondent no.3. It has filed its counter affidavit

highlighting the advance form of medical facilities available in MAX

hospital.

8. Having regard to the averments made in the affidavit of respondent

no.1 and 2, we are of the opinion that no mandamus can be issued to the

government to provide basic life support training to each and every

category of employee . The purpose is to provide first possible medical

attendants to the patient who are admitted in such hospitals and the

respondent are in a better position to know which categories of employees

are to be given training in basic life support services and other categories of

employees who are sought to be covered by the petitioner, may not require

such extensive training. Instead, for them, different kind of training namely

making them aware of standard operating procedures and protocols

pertaining to the care of the patients is more important. Such staff does not

come in contact with the patient. Insofar as medical attendant is concerned,

their main job could be alert the nurses and Doctor on duty so that life

support can be provided by the concerned responsible officer. No doubt,

what the petitioner points out could be the ideal situation. No doubt, State

of Gujarat has legislated on this aspect and if that happens in other part of

the country including in Delhi, that may go a long way in improving the

medical care. At the same time, having regard to the nature of duties

which other employees have to perform and medical care is not a part of

their duty, it is difficult to issue a mandamus for providing such medical

training related to life support system, to these category of staff as well.

Financial burden is a valid consideration when the decision on such aspects

is to be taken . The Government of Delhi has already taken up the issue

with all seriousness for which meetings are held at the appropriate level and

the matter is under consideration, we can only comment that in right

quarters, the matter shall be discussed with all seriousness and sincerity

which it requires and decision taken thereupon.

9. Writ petition stands disposed of with these observations.

1.

ACTING CHIEF JUSTICE

(RAJIV SAHAI ENDLAW) JUDGE JULY 13, 2012 skb