Vikas Saini And Anr vs Directorate Of Health Services ...
2014 Latest Caselaw 5576 Del

           *IN THE HIGH COURT OF DELHI AT NEW DELHI

%                                  Date of decision: 10th November, 2014

+                               W.P.(C) No.6436/2012

       VIKAS SAINI AND ANR                                 ..... Petitioners
                     Through:         Mr. Rajiv Garg, Mr. K.K. Aggarwal
                                      and Ms. Gayatri Aggarwal, Advs.
                                Versus
    DIRECTORATE OF HEALTH SERVICES
    AND ORS                                 ..... Respondents
                  Through: Ms. Ferida Satarawala, Adv. for
                           GNCTD.
CORAM :-
HON'BLE THE CHIEF JUSTICE
HON'BLE MR. JUSTICE RAJIV SAHAI ENDLAW

RAJIV SAHAI ENDLAW, J.

1. This petition under Article 226 of the Constitution of India, filed as a

Public Interest Litigation, flags the issue of lack of essential emergency

facilities in Cardio Vascular Department in Satyawadi Raja Harish Chander

Government Hospital and Maharishi Valmiki Hospital being the only

Government hospitals in the locality of Narela stated to be having a population

of over 10 lakhs, compelling the residents of the said locality even in an

emergency to travel long distances in peak traffic and which often proves fatal

The petition seeks a direction to the respondent Directorate of Health Services,

Govt. of NCT of Delhi (GNCTD) to provide the said facilities in the said

Government hospitals.

2. The petition was entertained and notice thereof issued.

3. A counter affidavit was filed on behalf of the respondent no.3 Health and

Family Department of GNCTD inter alia stating that Maharishi Valmiki

Hospital, a 150 bed hospital has a 4 bed ICU and round-the-clock facility for

ECG at Casualty; that the ICU is equipped with ventilator and defibrillator and

is managed round-the-clock by doctors and other staff. It is further stated that

the said hospital also has a facility for Troponin-T which is an important

diagnostic tool for detecting heart attack and routine Thrombolysis is carried

out in appropriate patients but patients needing invasive procedure on urgent

basis are transferred to higher centres for treatment. With respect to Satyawadi

Raja Harish Chander Hospital, the said affidavit states that the hospital

provides only basic health care to patients, who if required are then referred to

higher centres for treatment / management.

4. The petitioners have filed rejoinder controverting the aforesaid counter

affidavit, relying on the reply dated 14th June, 2011 of the Office of the Medical

Superintendant of the Satyawadi Raja Harish Chander Hospital stating that the

said hospital was not having Intensive Cardiac Care Unit and the required staff

though has the equipment to deal with few cardiac cases as a first aid but it is

not sufficient to deal with all cases.

5. This Court vide order dated 29th May, 2013 directed the Health and

Family Welfare Department of GNCTD to nominate an officer to inspect the

subject hospital and submit the Report. A Committee was so constituted and

which has submitted a detailed Report dated 20th June, 2013 inter alia to the

effect that:-

(a) The main surgery OT is not functional and surgery ward is locked

due to non-availability of surgery specialist;

(b) Though there are three senior residents in surgery department but

are not performing emergency surgeries and OT of casualty/

emergency is converted into minor OT;

(c) Though there are two transport ventilators in the casualty

department but one was found under lock and key and none of the

staff including Doctors knew how to operate the transport

ventilator;

(d) For cardiac cases, diagnostic tests like CPK (MB) are not

available;

(e) There are no protocols to handle the acute emergency cases;

(f) Surgery and orthopaedic senior residents are available till 1600

hours only; hardly any emergency cases are being done between

1600 hours and 0900 hours;

       (g)     No ENT specialist is posted;

       (h)     No proper utilization of manpower and equipment to cover

               emergency care round-the-clock;

       (i)     Manpower is not adequate; and,

       (j)     There is no ICU,

With respect to Maharishi Valmiki Hospital it was stated that it has a 4

bedded ICU equipped with anaesthesia machine, emergency cart, multipara

monitor (including cardiac monitor),defibrillator, ABG machine, intubation set,

AMBU bag, D and B type oxygen cylinders, suction machine, central supply of

medical gases and suction, portable X-ray machine but was lacking in:-

(i) Senior Residents for emergency services after 1600 hours;

(ii) Emergency LSCS between 1600 hours and 0900 hours;

       (iii)    ECG technicians after 1600 hours;

       (iv)     Protocols to handle the acute emergency cases;

       (v)      Diagnostic tests like CPK (MB) for cardiac cases; and,

       (vi)     Manpower.

6. The report aforesaid also made the following recommendations:-

"1. Recommendations given by the committee constituted by the department of health and family welfare, Govt. of NCT of Delhi for strengthening for existing ICU and central supply of medical gases and suction should also be implemented in these two hospitals.

Satyawadi Raja Harish Chandra hospital is recommended to have new 6 bedded level I ICU. Maharishi Balmiki hospital ICU is recommended for upgradation to 6 bedded level I ICU.

2. A technical committee should be constituted to recommend about the protocols / upgradation of the existing accident and emergency services including pre hospital care and transportation in Delhi, in terms of infrastructure, manpower and equipments, based on the bed strength of the hospital, location of the hospital and local needs to the all type of emergencies.

3. there is a need of regular teaching and training and sensitization of all types of staff posted in these critical areas like accident and emergency department, different type of ICUs and central

supply of medical gases and suction and support services i.e. Radiology, blood bank and other laboratories (round the clock).

4. The high turnover of the staff recruited / posted should be addressed.

5. Duty roster of the existing staff should be primarily focused to take care of all types of emergencies (medical and surgical) round the clock including support services.

6. Health and family welfare department, Govt. of NCT of Delhi, can consider to have one super specialty hospital in north-west district, in view of the needs of the catchment area and the distances from one hospital to another hospital."

7. This Court vide order dated 7th August, 2013 directed the respondents to

file affidavit indicating the steps taken to rectify the capacity gaps as pointed

out in the aforesaid Report.

8. Thereafter from time to time Status Reports of the steps taken have been

filed. Vide order dated 22nd January, 2014 another inspection of the hospitals

was ordered by the same team of Doctors who had earlier inspected the

hospitals. A Report of inspection on 3rd February, 2014 has been filed which is

indicative of the deficiencies in the hospitals persisting and the

recommendations earlier made having not been implemented. Appalled

therefrom, personal presence of the Secretary, Health & Family before this

Court was requested. The said official appeared and apprised this Court of the

steps being taken to remove the deficiencies and fulfill the recommendations

aforesaid. Thereafter from time to time Status Reports have been filed with the

last Status Report dated 25th June, 2014 being filed.

9. We heard the counsels for the parties on the petition on 17 th September,

2014.

10. The counsel for the petitioners handed over to us a copy of the

"Guidelines for District Hospitals (101 to 500 Bedded)" published by the

Directorate General of Health Services, Ministry of Health & Family Welfare,

Government of India as revised in the year 2011 and contended that the

aforesaid two hospitals ought to be brought in consonance therewith.

11. The counsel for the respondents though not controverting that the lacunas

/ deficiencies persist stated that endeavours for the said hospitals to provide the

essential medical services including in emergency, to the residents are being

made. She also pointed out that as reported in the Status Report dated 25 th June,

2014, a two bed Cardiac Care Unit has been created and operationalized in the

Maharishi Valmiki Hospital. With respect to the manpower it was stated that

the process of making the appointments has begun.

12. As far as the contention of the counsel for the petitioners, of the said

hospitals to comply with the aforesaid Guidelines is concerned, the counsel was

unable to show that the said Guidelines are mandatory. The counsel for the

respondents stated that due to constraints on various fronts including financial it

is not possible to make the hospital comply with all the Guidelines in a time

bound manner though endeavour therefor will be made. It was also pointed out

that though the national average of expenditure in the health sector is only

4.15%, the city of Delhi with a population of just over 1% of the national

population has a health budget in excess of 10% of the State budget.

13. We are of the view that no purpose will be served in directing

compliance with the aforesaid Guidelines in a time bound manner and in fact

such a direction may not even be proper. The Supreme Court in State of

Punjab Vs. Ram Lubhaya Bagga (1998) 4 SCC 117 has held that such

directions cannot be made.

14. We accordingly dispose of this petition with a direction to the respondent

to within one year hereof remove all the deficiencies / lacunas pointed out by

the Committee of Doctors in their Reports dated 20 th June, 2013 and 3rd

February, 2014 and to comply with all the recommendations made therein.

RAJIV SAHAI ENDLAW, J

CHIEF JUSTICE NOVEMBER 10, 2014/„pp‟