Gujarat High Court
Devarshi Pragneshbhai Patel vs State Of Gujarat & 1....Opponent(S) on 26 February, 2015
Bench: Vijay Manohar Sahai, R.P.Dholaria
C/WPPIL/33/2015 ORDER
IN THE HIGH COURT OF GUJARAT AT AHMEDABAD
WRIT PETITION (PIL) NO. 33 of 2015
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DEVARSHI PRAGNESHBHAI PATEL....Applicant(s)
Versus
STATE OF GUJARAT & 1....Opponent(s)
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Appearance:
MR JAYANT P BHATT, ADVOCATE for the Applicant(s) No. 1
MR JEET J BHATT, ADVOCATE for the Applicant(s) No. 1
MR. KAMAL TRIVEDI, ADVOCATE GENERAL ASSISTED BY MS.
SANGEETA VISHEN, AGP, for the Opponent(s) No. 1
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CORAM: HONOURABLE THE ACTING CHIEF JUSTICE MR.
VIJAY MANOHAR SAHAI
and
HONOURABLE MR.JUSTICE R.P.DHOLARIA
Date : 26/02/2015
ORAL ORDER
(PER : HONOURABLE THE ACTING CHIEF JUSTICE MR. VIJAY MANOHAR SAHAI) We have heard learned senior advocate Mr. Shalin Mehta assisted by learned advocate Jeet Bhatt for the petitioner and learned Advocate General Mr. Kamal Trivedi assisted by learned AGP Ms. Sangeeta Vishen for the respondents.
2. In pursuance of our directions issued on 19.2.2015 to the State Government as well as to the Chief Secretary for monitoring and taking effective steps to prevent and control Swine Flu in the State of Gujarat, an affidavit has been filed by the State Government indicating various measures which have Page 1 of 16 C/WPPIL/33/2015 ORDER been taken by the State Government to control and to provide treatment for swine flu to the patients of swine flu. Further, we also appreciate the efforts made by the State Government in impressing upon the private hospitals to co-operate with the State Government for treating the patients. We also record our appreciation for the private hospitals in rising to the occasion and providing free medical treatment to swine flu patients whereas the State Government is also providing free medicines to the private hospitals.
3. The measures which have been taken by the State Government as stated in the affidavit in reply are as under:
"I respectfully say that immediately on the next day, i.e. 20.2.2015, the Office of the Commissioner, Health, Medical Services, Medical Education and Research, issued a circular to all the Municipal Commissioners and the Collectors in the State of Gujarat, inter-alia instructing them to immediately request all the private hospitals having ICU facilities to provide free of cost medical facilities and treatment to the patients manifesting symptoms of Swine Flu. It has also been instructed to obtain the consent from the respective private hospitals indicating the nature of medical services which the private hospital would provide free of cost. I respectfully say that it has been mentioned that the private hospitals are being provided with curative medicine, viz. Tamiflu, free of cost as well as laboratory diagnoses of Swine Flu patients in the Medical Colleges of the State Government. Similarly, Chief Secretary of the State has also issued two circulars dated 18.2.2015 and 20.2.2015 in this behalf. Annexed hereto and collectively marked as Annexure-I (Colly.) are the Page 2 of 16 C/WPPIL/33/2015 ORDER copies of the said circulars.
Upon instructions gathered from all the Municipal Commissioners and Collectors, I respectfully say that meetings were convened by the respective Municipal Commissioners and Collectors with the representatives of private hospitals seeking their co-operation in providing free treatment to the patients of Swine Flu. Apropos the said meetings, 326 private hospitals have shown their readiness and willingness to provide the treatment free of cost. I respectfully say that pursuant to the aforesaid meetings, the following position has emerged:
Sr. No. of Nature of treatment agreed
No. private to be provided free of cost.
hospitals
1. 295 Free OPD (Outdoor Patient Department)
consultation and treatment.
2. 116 Indoor Stable patients
3. 49 Indoor Critical patients.
I respectfully say that the private hospitals have agreed to provide the aforesaid treatment subject to certain conditions, which are summarized as under:
(i) Majority of the hospitals have agreed to provide treatment only to BPL patients;
(ii) Many other hospitals have agreed to provide 10% to 50% relief in the cost of treatment and doctor's visit of indoor patients.
Annexed hereto and collectively marked as Annexure-II (colly.) are the copies of the list of summary of responding private hospitals in t he State as well as t he list carrying names of all the 326 private hospitals along Page 3 of 16 C/WPPIL/33/2015 ORDER with the nature of treatment agreed to be provided.
I respectfully say that further, the steps taken by the State Government which have been recorded in para-4 of the order dated 19.2.2015 of this Hon'ble Court, are being continuously and rigorously implemented and the same are being closely and constantly monitored by the Chief Secretary of the State as well as Secretary (Health), heading the State Task Force which has been constituted for day-to-day monitoring effective implementation of preventive, control and curative measures relating to Swine Flu. I respectfully say that I crave leave to refer to and rely upon the minutes of various meetings convened under the Chairmanship of the Chief Secretary as well as the Secretary (Health), State Task Force, at the time of hearing of the captioned petition.
The epidemic branch of the office of Commissionerate of Health, Family Welfare and Medical Services, has issued Information Manual, indicating various aspects relating to Influenza A-H1N1, popularly known in common parlance as swine flu. The said Manual is compendium of various readily available guidelines to the Doctors and Specialists serving in Government and/or Private Sectors dealing with infections like influenza. The said Manual consists of appendices and providing for following guidelines:
(i) Appendix - I - Clinical Management Protocol
(ii) Appendix - II - Standard Operating Procedures on use of personal protection equipments
(iii) Appendix - III - Guidelines / Operating Procedures for infection control practices Page 4 of 16 C/WPPIL/33/2015 ORDER
(iv) Appendix - IV - Criteria to determine Community Spread
(v) Appendix - V - Guidelines for Screening Centres and Isolation Facilities
(vi) Appendix - VI - Guidelines on categorization
(vii) Appendix - VII - Guidelines on use of mask
(viii) Appendix - VIII - Guidelines for Diagnostic Laboratories
(ix) Appendix - IX - Guidelines for sample collection
(x) Appendix - X - WHO recommendations for the post pandemic period I respectfully say that the respondents had adhered to the aforesaid guidelines and consequently, have implemented the guidelines by having inter alia undertaken the following steps:
(i) Continuous surveillance of Influenza-Like Illness ('ILI' for short) for identifying the clustering of such cases in community on weekly basis by Integrated Disease Surveillance Programme ('IDSP' for short);
(ii) On the basis of the aforesaid surveillance, report is generated on weekly basis and analyzed.
(iii) Feed-back from the said report is given to concerned Units for further action.
(iv) State Task Force consisting of 8 to 10 Experts in
Page 5 of 16
C/WPPIL/33/2015 ORDER
various fields, like Public Health, Medicine, Microbiology, Preventive and Social Medicine has been constituted.
(v) The State Task Force is meeting on regular intervals to review the situation across the State for taking up required actions.
(vi) Crisis Management Group has been formed as per the Guidelines of the Ministry of Health & Family Welfare, Government of India, under the Chairmanship of the Secretary (Health) and Executive Committee of Crisis Management has been formed under the Chairmanship of Additional Director (Public Health) which meets at regular intervals, as frequently as the situation demands, and makes recommendations for necessary action.
There are already 5 Specialized Laboratories of Bio-Safety Level-2, as per the specified Guidelines of WHO, which are capable enough for testing any sample coming from any corner of the State within 24 hours. The said 5 Laboratories are located at the following places:
(a) B.J. Medical College, Ahmedabad.
(b) Govt. Medical College, Surat;
(c) PDU Medical College, Rajkot;
(d) GMERS Medical College, Sola, Ahmedabad;
and
(e) GAIMS Medical College, Bhuj (Kutch)
The aforesaid Laboratories are equipped for Swine Flu testing, and they are sufficient to take care of the present day situation. These Laboratories are not merely Page 6 of 16 C/WPPIL/33/2015 ORDER required to have specialized accreditation but they also require specialized trained Experts with State-of-Art facilities relating to protection of human health and safety. Though establishment of one such Laboratory takes about 3 to 4 months.
However, the State Government has already taken a decision to provide three more laboratories in the State at Vadodara, Bhavnagar and Jamnagar Medical Colleges, for which necessary process has already been initiated about one month back and the said laboratories are expected to be fully functional within next two months.
The State Government, the following steps have been taken in furtherance of providence of proper treatment and prevention of the spreading of virus of the swine flu.
(i) Separate OPDs for Influenza A H1N1 have been started in all district hospitals and civil hospitals.
(ii) Isolation wards with dedicated ventilators have been created in all hospitals.
(iii) Private hospitals treating such patients are being inspected by experts from medical colleges for confirmation of the availability of necessary facilities as per guideline.
(iv) All hospitals, treating Influenza A H1N1 patients are being visited by expert teams to verify facilities and adherence to treatment protocols and universal precautions for infection control.Page 7 of 16
C/WPPIL/33/2015 ORDER (v) Screening and reporting of ARI cases in OPD have
been intensified to the state epidemic branch.
(vi) Contacts of all confirmed cases are followed up regularly for 10 days and symptomatic contacts are given anti viral treatment.
(vii) Stock of anti viral drug Cap and Syrup Oseltamivir, PPE kit, N- 95 masks and triple layer masks is ensured in ample quantity at all levels in the state. Cap Oseltamivir is made available at all levels including PHCs, CHCs, Sub District Hospitals, District Hospitals and Medical Colleges.
All treatments including drugs and ventilator care is given free of cost to all patients in all Government-run hospitals.
(viii) Advanced rtPCR machine (real time polymerase chain reaction machine), deep freeze -200 C, deep freeze
-700C, refrigerated micro centrifuge were purchased and given to civil hospitals. Additional 42 ventilators were made available in different medical college civil hospitals.
(ix) More than 800 beds are available in isolation ward in government hospitals and about 200 ventilators are available for Influenza A H1N1 patients. This capacity can be increased as per need.
(x) Rapid Response Team of PDU Medical College have visited most affected Kutch district and investigated the outbreak and given the necessary information.
When the said Influenza A H1N1 virus was detected for the first time in the year 2009, the same was declared Page 8 of 16 C/WPPIL/33/2015 ORDER pandemic disease by the WHO since the same was found to be available in more than one country in the world, at the time when the said virus was not only new to the human world having practically no immunity, but no proper and effective medicines to fight the said virus were known, with the result the WHO had declared at that time that the said virus had a potential of causing death of millions of people worldwide. It was under these circumstances that at that time, the State in consultation with the Central Government, had issued a notification dated 18.8.2009 under the provisions of section 2(1) of the Epidemic Diseases Act, 1897. At present the influenza A H1N1 virus is being treated as 'seasonal influenza', meaning thereby that pandemic influenza A H1N1 virus has ceased to be pandemic, all the conditions set out in the aforesaid notification dated 18.8.2009 relating to epidemic or influenza A H1N1 virus are being taken care of in letter and spirit. The mortality rate has also been substantially reduced from 35% which was in last year. The State is not leaving any stone unturned to control the spread of Swine Flu and that one should not be carried away by mere statistics, more particularly when many of the affected persons do not immediately come forward for early diagnoses and treatment due to delayed healthcare seeking behavioral pattern among the people at large, perhaps under the misconception that they are suffering from common cold symptoms resorting to self- medication, which in turn results into medical complications. However, now this trend has started Page 9 of 16 C/WPPIL/33/2015 ORDER declining in view of there being extensive publicity and awareness campaign being organized by the State and its authorities on regular basis.
Committee consisting of Experts to give a correct picture as well as guide the respondents to combat the swine flu in a more effective manner, is concerned, three Committees of Experts have already been constituted in line with the aforesaid guidelines. The details whereof are as under:
(i) Crisis Management Group headed by Secretary (Health) - oversees the functions performed by the administration and seeks support from other Governmental Department and Divisions if necessary.
(ii) State Task Force Group headed by Additional Director (Public Health) - it consists of Experts from Public Health, Medicine, Preventive and Social Medicines, Microbiology and experts from medical services and medical education. It meets at least once in a quarter or as may be required and intensifies surveillance and control mechanism throughout the State to address upsurge of any disease of public health importance.
(iii) Sub-Committee on Epidemic-Prone Diseases headed by State Surveillance Officer - which provides feed-back on weekly basis on all epidemic prone diseases including airborne, waterborne and other communicable diseases.
The State Government has issued inasmuch as, sufficient guidelines in the form of Manual in line with the guidelines issued in accordance with advanced practices in various countries. The State Government has made exhaustive manual, enumerating the policies, guidelines and protocol for controlling the spread of the disease.
Page 10 of 16C/WPPIL/33/2015 ORDER The respondent authorities are, by way of preventive measures, providing the vaccine for swine flu free of cost to the intended beneficiaries as per the guidelines issued by the Ministry of Health and Family Welfare, Director General of Health Services (Emergency Medical Relief), Government of India. I respectfully say that as per the said guidelines, Health Care Workers working in close proximity to influenza patients who are at higher risk of acquiring the disease, vaccination is being provided free of cost. More than 2000 health care workers and doctors, involved in treatment of such patients are vaccinated with Influenza A H1N1 vaccines free of cost and not at the subsidized rate and for curing this kind of complications, one has to go for curative measures like Early Diagnoses and Prompt Treatment (EDPT) by taking medicine which is dispensed as capsule Oseltamivir, popularly known as 'Tamiflu', having potent anti-virus properties and if taken within 48 hours of manifestation of symptoms of A H1N1, it works as magic bullet and more than 90% of the viral load of the patients gets decreased in just 3-4 doses and will get cured within five days. Usual symptoms of influenza A H1N1 are of malaise, body-ache, sore-throat, dry cough, run-nose, high grade fever of around 100oF to 102oF The medicines are provided free of cost by the State Government.
The State Government has also taken the following steps:
(i) Sensitization workshop and training were conducted Page 11 of 16 C/WPPIL/33/2015 ORDER at district and taluka level for all private practitioners by local IMA branch and health authority.
(ii) Pamphlets were distributed in major public gatherings and in community for Do's and Don'ts for prevention and control of Swine Flu.
(iii) A mass awareness campaign was carried out in Kutch district, which reported higher number of cases during earlier weeks. About 3.6 lac population of 70,000 houses were contacted and given information regarding Influenza A H1N1.
(iv) Such awareness campaign was then replicated in the entire state. Till date, more than 4 crore people have been sensitized by house-to-house visit. 86 lac houses have been visited by 1.6 lac volunteers and health-
workers to spread information on Swine Flu and basic preventive measures.
(v) Radio jingle for awareness and precautions were given in Akashvani and FM radio including interviews of public health experts with radio jockey on the subject on FM Radios at the prime time
(vi) L-band, scrolls and advertisements on news channels and talks show with experts on Radio and Television was done.
(vii) Advertisements on print media are being regularly issued in leading newspapers .
(viii) Hoardings, Flex banners on Swine Flu symptoms Page 12 of 16 C/WPPIL/33/2015 ORDER and care are put at public places, like, hospitals, milk dairy, school, colleges, railway stations, bus stations, etc.
(ix) Manual of influenza A is available on website of website www.gujhealth.gov.in and circulated to all PHC, CHC, DH and Medical College Hospital and private hospitals.
(x) Advisory for care of students in schools is circulated through Department of Education to take care of any student suspected of Influenza A H1N1.
(xi) The Chief Secretary, Gujarat has been taking the meeting of all Collectors, DDOs and Municipal Commissioners along with health officials through video conference and giving the instructions for containment of outbreak. "
4. The Collector, Ahmedabad, has also issued a Notification under Section 144 of the Cr.P.C. on 23.2.2015 in vernacular language for effectively controlling the spread of swine flu. The English translation of which is reproduced as under:
"Presently, it is found that epidemic of Swine Flu Influenza (H1N1 SWINE FLU) is getting spread in the entire state along with Ahmedabad district. The symptoms of the same are chills, fever, cough, vomiting, sore throat, body pain, severe headache, coughing and weakness. The virus of this epidemic mainly enters into body through mouth and nose from the places where people gather in groups and they enter into the lungs through respiratory system and affect the lungs. As this epidemic is contagious, it can spread from one person to Page 13 of 16 C/WPPIL/33/2015 ORDER other easily. In this way, to prevent this serious contagious disease, it seems necessary to impose certain restrictions in the public interest.
Therefore, I, Rajkumar Benival, District Magistrate, Ahmedabad hereby declare under section 144 of the Criminal Procedure Code that, (1) In the public places of the entire Ahmedabad district, no programme of any type such as gathering, procession, convention or folk festival, wherein people would gather in large number, shall be organised without the prior written permission of the competent authority or the people also should not gather in large number in such programmes.
The person getting approval shall make the following arrangements during this programmes without fail.
- Masks should be distributed free of cost.
- Facilities such as disposal of masks shall also be provided.
- Facility of washing hand with soap should be provided and boards etc. shall be displayed to provide information of swine flu.
(2) High standards of cleanliness shall have to be maintained at the places of eatery, hotels, restaurants, confectionery, farsan shops, dining halls, etc. (3) Vegetables / fruit vendors should not keep vegetables or fruits open after chopping or should not sell such items by making pieces.
(4) Ancillary arrangements including soap and water should be provided at community meals being Page 14 of 16 C/WPPIL/33/2015 ORDER organized in private places like marriage halls and party plots so that the persons taking part can wash their hands properly before taking meal.
(5) If any person is diagnosed with the disease of Swine Flu Influenza (H1N1 Swine Flu), complete details of such patient should be sent to nearby Primary Health Centre, Government Hospital or District Health Office by the family member or an attendant who is taking care of that patient.
Area This notification shall be applicable to entire Ahmedabad District including revenue area.
Exception The provisions of the order shall not be applicable to the below mentioned programmes.
A) Approval has been obtained from the competent authority for aforesaid clause-1 B) Any programmes organized in the interest of public at large by the government or local self government body C) Marriage procession, funeral procession or programmes organized by the government or local self government body.
Any person violating any clause of this notification shall be punishable u/s 188 of the Indian Penal Code.
This notification shall remain in force from today 23/02/2015 to 22/04/2015."
5. We are satisfied that the State Government has taken very effective methods and they may continue with the same and the manner in which the State Government has Page 15 of 16 C/WPPIL/33/2015 ORDER taken steps to prevent and control swine flue shows that it is interested in the welfare of the people of Gujarat. We also request the State Government to take effective steps in Rural areas also.
List this matter again on 9.3.2015.
(V.M.SAHAI, ACJ.) (R.P.DHOLARIA,J.) (pkn) Page 16 of 16